Using a decision support tool to reduce inappropriate antibiotic use after a delayed prescription.

Antimicrobial resistance is partly driven by overprescribing antibiotics in primary care. Delayed antibiotic prescriptions, which allow patients to monitor their symptoms before deciding to use antibiotics, are a promising intervention. However, this strategy is undermined when patients initiate antibiotic use immediately. Using a behavioural game measure with behaviour-contingent financial incentives that models delayed prescriptions, we examined whether a decision support leaflet issued by the World Health Organization can, alone or in combination with other evidence-based interventions, reduce inappropriate antibiotic use for viral infections. In a pre-registered online experiment (N = 663 UK adults), participants were randomly assigned to one of five experimental conditions: (i) control condition, (ii) leaflet only, (iii) leaflet with value integration task, (iv) leaflet with active symptom monitoring and (v) leaflet with value integration and active monitoring. Inappropriate antibiotic use was lower in all decision support conditions than in the control condition (p < .001, ηG 2 = .02). Decision support tools also reduced decisional conflict (p < .001, ηG 2 = .02), particularly by improving value clarity and perceived decisional support. Integrating decision support tools into delayed prescription procedures can contribute to a more informed and responsible approach to antibiotic use by providing relevant information and tools.