Evaluation of a co-designed, low-resource intervention to improve antibiotic prescribing for upper respiratory tract infections in Aotearoa New Zealand: a prospective, pre–post intervention study

Background Aotearoa New Zealand has high rates of community antibiotic use, with substantial seasonal variation suggesting overuse for self-limiting upper respiratory tract infections (URTIs). We aimed to co-design, implement, and evaluate a multifaceted, low-resource intervention intended to improve antibiotic prescribing for URTIs in general practices. Methods In this pre–post intervention study, we recruited general practices across Aotearoa New Zealand through the MyPractice system. There were no exclusion criteria and, once a practice was recruited, all general practitioners (GPs) at a practice were included in the study. Māori and Pacific community focus groups (March–April, 2021) and GP workshops (October–November, 2021) informed development of a suite of seven interventions that included GP or practice commitment posters, evidence-based infographics provided to GPs, prescribing templates for symptomatic relief, monthly prescriber feedback reports, and a patient education website. The interventions were implemented in the MyPractice electronic health record system and in participating practices between Aug 1, 2024, and Dec 31, 2024. Antibiotic prescribing rates during the intervention period were compared with those from the same GPs during the same months in 2023. The primary outcome was the proportion of URTI consultations resulting in an antibiotic prescription at the prescriber level, analysed through generalised estimating equations, comparing 2023 with 2024. Findings 16 of 62 general practices that used MyPractice participated in the study. 77 GPs participated, providing 79 763 consultations for 43 194 patients during the intervention period, including 5317 consultations for patients with an URTI. During the intervention period in 2024, 1668 (31·4%) of 5317 patients with URTIs were younger than 10 years, 2949 (55·5%) were female, 658 (12·4%) were Māori, and 1290 (24·3%) lived in areas with the highest level of socioeconomic deprivation. Among 69 GPs with data for both 2024 and 2023, the mean antibiotic prescribing rate for all URTI consultations decreased from 46·3% (SD 16·1) in 2023 to 43·5% (SD 16·3) in 2024 (mean difference –2·78 percentage points [95% CI –5·16 to –0·41]; p=0·022). Interpretation A co-designed, low-resource intervention package was associated with a clinically modest but statistically significant reduction in antibiotic prescribing for URTIs in Aotearoa New Zealand general practices. Future controlled studies are needed to substantiate these results. The approach was practical and minimally disruptive to GP workflow.