Tool - Intervention matrix for appropriate antibiotic prescribing

There is considerable variation in how often and how out-of-hours general practise services prescribe antibiotics. This indicates that there is room for improvement. To support these services in appropriate antibiotic prescribing, Nivel has developed an evidence-based intervention matrix.

The intervention matrix

The intervention matrix provides an overview of interventions that have been evaluated in international scientific studies with the aim of promoting responsible antibiotic use. The content is based on a pragmatic literature review and serves as a practical tool for anyone involved in antibiotic policy making in out-of-hours primary care.

How to use the intervention matrix?
The matrix brings together different types of interventions. Users can easily filter, for example on interventions aimed at training healthcare professionals. Each intervention includes a link to its original scientific source. The matrix enables policymakers and healthcare professionals explore, compare, and potentially apply interventions within their own context.

Example: getting started with audit & feedback

Imagine you want to provide healthcare professionals at an out-of-hours primary care centre insight into their prescribing behaviour, with the aim of promoting more appropriate antibiotic use.

Just as general practitioners in regular daytime practice receive feedback through tools such as pharmacotherapeutic peer review meetings, benchmarking information at out-of-hours services can also raise awareness and support more appropriate prescribing.

What can feedback be based on? 

Select a limited number of clear and measurable indicators, for example:

• Percentage of consultations for respiratory tract infections with an antibiotic prescription
• Percentage of prescriptions that comply with guidelines (correct drug, dose and duration)
• Use of ‘second-line’ antibiotics (such as amoxicillin/clavulanic acid)
• Number of delayed prescriptions
• Variation between healthcare professionals (benchmarking / peer comparison)

What will you find in the intervention matrix? 

In the intervention matrix, you can filter on ‘Audit & feedback’. You will see an overview of scientific studies in which this intervention has been evaluated, including:
•    the format of feedback (individual, team-based, or group sessions)
•    how the intervention was implemented in practice
•    perceived barriers and facilitators
•    measured effects on prescribing behaviour

How can you increase the impact of this intervention? 

1. Combine with other interventions
   • Patient education (posters, leaflets, online information)
   • Communication training for healthcare professionals
   • Clinical decision support in the electronic health record (EHR)
2. Use a cyclical approach and continuously improve
   • Repeat feedback every 3-6 months
   • Use a PDSA cycle (Plan-Do-Study-Act)
3. Work with clear targets
   • For example: “10% fewer antibiotic prescriptions for bronchitis”
   • Make progress visible in dashboards
4. Appoint key drivers
   • For example, a general practitioner or pharmacist who monitors and promotes the process in the workplace, in coordination with management 
5. Embed in existing structures
   • Integrate feedback into existing meetings and workflows

About the project

The intervention matrix is part of a broader Nivel project on appropriate antibiotic prescribing in out-of-hours general practice services. In collaboration with policymakers, healthcare professionals, and patients across the Netherlands, interventions and experiences have been collected.

This knowledge is brought together in a national learning platform for policymakers involved in antibiotic prescribing in out-of-hours primary care. The platform aims to share knowledge and insights, strengthen collaboration and further optimize antibiotic use in the Netherlands.

More information?

You can view the project description (in Dutch) or contact one of the researchers for more details.