5 minutes with… Anna Sallis
A recent trial involving more than 1500 GP practices found that writing to GPs about their antibiotics prescribing resulted in 73,000 fewer prescriptions over six months. The trial (see tinyurl.com/hwoagnr), a collaboration between Chief Medical Officer Dame Sally Davies, Public Health England (PHE), and the Behavioural Insights Team, was part of the government’s plans to slow the growth of antimicrobial resistance. We spoke to Anna Sallis, a health psychologist at the PHE Behavioural Insights Team, for more on the trial and what the future holds for the team.
Why did you have an interest in working in the Public Health England (PHE) Behavioural Insights Team?
The potential to design and conduct robust behaviour change interventions that can have an immediate and widespread impact on supporting healthy choices attracted me.
I trained as a health psychologist whilst working as a government social researcher and later as a Senior Psychologist at the Department for Work and Pensions. My work involved applying health psychology theory and evidence to policy in health and work, sickness absence and welfare reform. Before this I worked at the Maudsley Hospital evaluating staff prevention and management of violence training.
Around the time I qualified in 2011, the Cabinet Office Behavioural Insights Team was becoming big news across government. This opened up many opportunities to apply behavioural science to policy, and I moved to the Department of Health to help set up their internal Behavioural Insights Team. Soon after this team was established and we had plenty of trials up and running, I moved on to become the expert adviser to the new PHE Behavioural Insights Team. I’m also on the British Psychological Society’s Behaviour Change Advisory Group, and am Policy Officer for the BPS Division of Health Psychology.
Can you give me a little background in how this trial on social norms feedback came about?
PHE leads implementation streams of the cross-government UK Five Year Antimicrobial Resistance Strategy with a remit to facilitate a reduction in total antimicrobial prescribing in primary care to 2009/10 financial year levels. Members of the research team had been involved in numerous policy trials demonstrating the impact of both behaviourally informed letters and social norms feedback on both health and economic outcomes. We know that social norms act as a marker for social comparison against which individuals evaluate the appropriateness of their own behaviour compared to others. Observed discrepancies then motivate the individual to change their behaviour to be in line with their peers.
Although medical practices have access to their own and others’ prescribing data, we do not know how many practices actively look at this and how much attention is paid to the information. Feeding back this data directly to named prescribers using a high-profile messenger (England’s Chief Medical Officer, Dame Sally Davies) highlights not only how GPs compare with others, but also that others can and do use it to monitor prescribing behaviour. To move the intervention from a passive letter to an active intervention, we included ‘behavioural instruction’ in the form of three simple, concrete actions that the Chief Medical Officer recommends GPs take in order to reduce their prescribing levels (give patients advice on self-care instead, consider offering a delayed prescription instead, and talk to other prescribers to ensure they are also acting).
What’s the future of the antimicrobial resistance work the team is doing?
We have a range of projects under way to deliver aspects of the UK Five Year Antimicrobial Resistance Strategy. These include translating the positive evidence from our social norms feedback randomised controlled trial (RCT) into routine practice, and we have been working with NHS England and the NHS Business Services Authority to send out similar letters in winter 2015/16 to all GPs in practices with high antibiotic prescribing rates.
We are currently implementing a cluster RCT with over 200 GP practices to test the impact of two interventions aimed at reducing patient demand for antibiotics and increasing GP commitment to not prescribing antibiotics when they are not clinically indicated. I am also leading a review of primary care antimicrobial stewardship policies and programmes; the aim of the review is to classify the interventions into the Behaviour Change Wheel set out by Susan Michie and colleagues, to identify gaps and opportunities for policy.
We are also involved in wider PHE work contributing to projects led by others, including the evaluation of evaluating the impact of Antibiotic Guardian (a pledge-based campaign aimed at both public and healthcare professionals to raise awareness of antimicrobial resistance), interviewing community pharmacists about antimicrobial resistance and designing an intervention to reduce inappropriate antibiotic prescribing in out-of-hours services.
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