Table 2 Exemplar organisational and behavioural change strategies corresponding to the VALUE model for improving appropriate antibiotic prescribing

Values and Aligning

Message consistency:

 • Standardised guidelines and agreed protocols in use across primary care sectors

Alignment between organisation and doctors:

 • Organisational-led email circulars leveraging these, sent in the name of established and valued institutional bodies

 • Reminders of the risks and impact of AMR in primary care practice, while also promote the need to make time or build in micro-strategies, especially in clinics with high patient load, for discussion on appropriate antibiotic prescribing, and the risks of inappropriate prescribing

 • Promoting shared decision-making through incorporation into clinics’ mission statements and inculcating such values to newly employed doctors during orientation, and utilise trigger videos which use patients’ experiences as discussion points, especially in larger clinics

 • Informal training to promote role modelling of appropriate patient counselling using mentorship programming for junior doctors

Alignment between doctors and patients:

 • Organisational promotion of continuity of care, encouraging patient ‘loyalty’, and delivering care through a fixed team of doctors such that understanding of antibiotic prescribing decisions can be shared and sustained over time

Liaison with patients

Communication aids:

 • To improve dealing with high patient loads through fast turnover communication tools (micro-strategies) such as decision aids with consistent messaging

 • Gamification strategies to empower public to make shared decision-making through gaming interventions aimed at engaging both patients (playing the game) and doctors in discussion about the takeaway messages from the game together

Use of monitoring data to track and Evaluate

Audit and feedback:

 • Use of routine monitoring data for audit and feedback on prescribing behaviours at the individual doctor level (closed feedback) and to benchmark organisations against one another (open feedback) shared at regular meetings or in email circulars

 • Distil research findings on AMR and inappropriate antibiotic prescribing into short, accessible briefs posted and disseminated in clinical settings (knowledge management practices)

Developing meaningful indicators

 • Incorporate shared decision-making as a key indicator measuring appropriate antibiotic prescribing

 • Measure and evolve elements of the VALUE model based on empirical evidence