Development and efficacy of a clinician‐targeted refresher course for treating nonpneumonia respiratory tract infections

Abstract

BackgroundIn 2017, the Japanese government published an evidence‐based manual describing the appropriate use of antibiotics in outpatient settings to tackle the problem of antimicrobial resistance. To fill the evidence‐practice gap, we developed a clinician‐targeted course aimed at improving clinician skills in the daily clinical practice of treating acute respiratory tract infections (RTIs) based on the manual. The aim of this study was to evaluate the efficacy of the course.MethodsThis course consisted of lectures using illness scripts and checklists, as well as interactive communication skills training using role‐playing. We performed a vignette‐based evaluation of the changes in the knowledge and attitudes of the course participants toward prescribing antibiotics for nonpneumonia RTIs, using pre‐ and postcourse questionnaires. The questionnaires also included course feedback via the use of a 5‐point Likert scale.ResultsThirty‐eight clinicians were included in the analyses, and 90% of these participants had graduated ≥20 years ago. We found statistically significant reductions in the intention to prescribe antibiotics for four of the six nonpneumonia RTI vignettes: acute bronchitis (−47.2%; 95% confidence interval [CI] −66.3 to −28.1%), common cold (−16.2%; 95% CI −30.8 to −1.6%), acute pharyngitis (−27.0%; 95% CI −49.0 to −5.0%), and acute rhinosinusitis (−33.3%; 95% CI −53.3 to −13.3%). The course seemed to be satisfactory for experienced doctors who were the relevant target population of such a workshop.ConclusionsThe refresher course was helpful for reducing the participants’ intensions to prescribe antibiotics for nonpneumonia RTIs.

Prevalence of Microorganisms in Acute Pharyngitis from Throat Swab in a tertiary care hospital

“…In current study 9% group A beta-hemolytic streptococcus (GABHS) was detected in children under 15 years which is in accordance to epidemiological statistics presented for other countries like 11%, 12% and 9.7% in Turkey, Brazil and Ethiopia respectively [11][12][13] . Low prevalence is found in India (2.8%) 14 and Taiwan (4.1%) 15 .…”

A nationwide questionnaire survey of clinic doctors on antimicrobial stewardship in Japan

“…Antibacterial stewardship has been highlighted in an issue of the Journal of the Japan Medical Association [30], and many Japanese doctors are already aware of its importance. Educational programs and information materials designed to promote antimicrobial stewardship have been shown to be beneficial in addressing prescription behavior among doctors in Japan and other countries [28,29,31,32]. To determine effective measures to address unnecessary antimicrobial prescriptions specifically at clinics in Japan, the background to such prescribing behavior and associated factors need to be investigated further.…”

Decline in oral antimicrobial prescription in the outpatient setting after nationwide implementation of financial incentives and provider education: An interrupted time-series analysis

“…We speculated that the incentives were not paired with other interventions, including ongoing education about rational antimicrobial use, performance feedback, and audits, all of which have been shown to improve the prescription of antimicrobials. 27,28 A continuing medical education course with this educational intervention material that was given by a local medical association succeeded in enhancing the providers' willingness to reduce the prescription of antimicrobials; 29 This study was distinct from others in terms of methodology. In previous studies, investigators employed the International Classification of Diseases, 10th Revision (ICD-10) to assess how policy changes, such as financial incentives and national guidance, affected antimicrobial prescription rates for a particular diagnosis.…”