Background: Effective community-based antimicrobial stewardship programs (ASPs) are needed because 90% of antimicrobials are prescribed in the community. A primary care ASP (PC-ASP) was evaluated for its effectiveness in lowering antibiotic prescriptions for six common infections. Methods: A multi-faceted educational program was assessed using a before-and-after design in four primary care clinics from 2015 through 2017. The primary outcome was the difference between control and intervention clinics in total antibiotic prescriptions for six common infections before and after the intervention. Secondary outcomes included changes in condition-specific antibiotic use, delayed antibiotic prescriptions, prescriptions exceeding 7 days duration, use of recommended antibiotics, and emergency department visits or hospitalizations within 30 days. Multi-method models adjusting for demographics, case mix, and clustering by physician were used to estimate treatment effects. Results: Total antibiotic prescriptions in control and intervention clinics did not differ (difference in differences = 1.7%; 95% CI –12.5% to 15.9%), nor did use of delayed prescriptions (–5.2%; 95% CI –24.2% to 13.8%). Prescriptions for longer than 7 days were significantly reduced (–21.3%; 95% CI –42.5% to –0.1%). However, only 781 of 1,777 encounters (44.0%) involved providers who completed the ASP education. Where providers completed the education, delayed prescriptions increased 17.7% ( p = 0.06), and prescriptions exceeding 7 days duration declined (–27%; 95% CI –48.3% to –5.6%). Subsequent emergency department visits and hospitalizations did not increase. Conclusions: PC-ASP effectiveness on antibiotic use was variable. Shorter prescription durations and increased use of delayed prescriptions were adopted by engaged primary care providers.

Parental substance use disorders (SUDs) for Māori, the indigenous people of Aotearoa/New Zealand and an ethnic minority, are considered to be contributors to adverse effects on outcomes for their children. This article offers a review of international and Aotearoa literature in regard to key considerations for Māori parents with SUDs who present to an Alcohol and Drug specialist for assessment and treatment. Factors to increase positive outcomes for Māori children of parents with SUDs are promoted. Effective adult AoD services provide support to parents with SUDs through comprehensive assessment and intervention plans that consider both individual and familial risk and protective factors. In this context, it is imperative that possible child welfare issues are identified early to ensure prevention or intervention. The AoD workforce must have the knowledge and skills to facilitate access to other relevant sectors, such as education, employment, and housing. An AoD workforce that is effective with Māori must not only have these abilities, but also have at least some basic knowledge and skills in Whānau Ora philosophy and Whānau-centered best practice. To address these processes, AoD specialist services need to acquire a set of knowledge and skills. These include increasing the knowledge and skills associated with the realities of lifestyles centered in low socioeconomic communities and co-occurring issues that contribute to poor health outcomes. To assist Māori, several key processes are proposed. This includes working in a Whānau-centered approach with Whānau as a collective entity, based on Māori foundations; understanding intergenerational dynamics; and endorsing a group capacity for self-determination. Research and training in Whanau ora philosophy and Whānau-centered best practices will be essential for developing an appropriate AoD workforce, which would provide the foundations for improving AoD service delivery for Māori parents with SUDs.

No abstract

No abstract