Table 1.

Characteristics, set-up and process of the PAR project in the three regions

	GPC 1	GPC 2	GPC 3
Urban/rural	Urban	Rural/urban	Rural
Number of GPs	185	275	137
Patients living in the area	185 839	251 289	140 095
Co-researchers	GPC board & manager Master’s student medicine Local GP trainee	GPC board & manager Quality commission GPC chairman	GPC board & manager GP board member Local GP trainee
Exploratory phase
Timing	2017–19	May 2018	Oct 2018
Actions	Prescribing feedback GPC board Co-creation meetings Exploratory work: Video observations—(elicitation) interviews (2017–18)	Prescribing feedback GPC manager and chairman Quality commission Co-creation meetings	Prescribing feedback GPC board Co-creation meetings
Initiated by	Academic researcher and local GP trainee	GPC chairman & quality commission	GP board member and local GP trainee
Facilitating change phase
Timing	September 2019–February 2020 (6 months)	September 2019–February 2020 (6 months)	September 2019–February 2020 (6 months)
Start of the interventions	Prescribing feedback at GPC level, compared with other GPCs  E-mail  Interactive co-creation sessions  Newsletter	Prescribing feedback at GPC level, compared with other GPCs  Newsletter  Interactive co-creation sessions	Prescribing feedback at GPC level, compared with other GPCs  Newsletter  Interactive co-creation sessions
Initial focus of intervention	Otitis media: reduction and choice of antibiotics	Otitis media: reduction and choice of antibiotics Tonsillitis: reduction of antibiotics Bronchitis: reduction and choice of antibiotics	Diverticulitis RTI Sick children reduction and choice of antibiotics
Interventions	Access to e-learning Desk stand with information Reminder e-mails Patient leaflets Poster	Pop-ups in EHR Local medical-pharmaceutical interdisciplinary meetings Patient leaflets Poster	CRP POCT with 1 to 1 training and guidelines Access to e-learning Patient leaflets Poster
Aim	Knowledge, enhance patient communication, raise awareness	Knowledge, enhance patient communication, raise awareness	Knowledge, decision support, enhance patient communication, raise awareness
PDSA cycles and evaluations	2 cycles Interviews with GPs & prescribing feedback	2 cycles Interviews with GPs & prescribing feedback	2 cycles Interviews with GPs & prescribing feedback
Adaptations after PDSA cycle	Focus of the intervention: promoting the newly published antibiotic guidelines: Choice of antibiotic Visibility of materials Implementation of pop-ups in EHR (adopted from GPC2)	Visibility of materials Choice to continue with same focus	Implementing newly published antibiotic guidelines Adaptation of posters
Evaluation phase
Evaluation	In-depth interview with local key person & online questionnaire with board and management	In-depth interview with local key person & online questionnaire with board and management	In-depth interview with local key person & online questionnaire with board and management
Response to COVID-19 pandemic	Study on hold: OOH care reformed to triage hubs	Study on hold: OOH care reformed to triage hubs	Availability of CRP POCT in the triage hubs, but little used