Enhancing the quality of antibiotic prescribing in Primary Care: Qualitative evaluation of a blended learning intervention

Abstract

BackgroundThe Stemming the Tide of Antibiotic Resistance (STAR) Educational Program aims to enhance the quality of antibiotic prescribing and raise awareness about antibiotic resistance among general medical practitioners. It consists of a seven part, theory-based blended learning program that includes online reflection on clinicians' own practice, presentation of research evidence and guidelines, a practice-based seminar focusing on participants' own antibiotic prescribing and resistance rates in urine samples sent from their practice, communication skills training using videos of simulated patients in routine surgeries, and participation in a web forum. Effectiveness was evaluated in a randomised controlled trial in which 244 GPs and Nurse Practitioners and 68 general practices participated. This paper reports part of the process evaluation of that trial.MethodsSemi-structured, digitally recorded, and transcribed telephone interviews with 31 purposively sampled trial participants analysed using thematic content analysis.ResultsThe majority of participants reported increased awareness of antibiotic resistance, greater self-confidence in reducing antibiotic prescribing and at least some change in consultation style and antibiotic prescribing behaviour. Reported practical changes included adopting a practice-wide policy of antibiotic prescription reduction. Many GPs also reported increased insight into patients' expectations, ultimately contributing to improved doctor-patient rapport. The components of the intervention put forward as having the greatest influence on changing clinician behaviour were the up-to-date research evidence resources, simple and effective communication skills presented in on-line videos, and presentation of the practice's own antibiotic prescribing levels combined with an overview of local resistance data.ConclusionParticipants regarded this complex blended learning intervention acceptable and feasible, and reported wide-ranging, positive changes in attitudes and clinical practice as a result of participating in the STAR Educational Program.Trial registrationCurrent Controlled Trials ISRCTN63355948

Clinicians’ Views and Experiences of Interventions to Enhance the Quality of Antibiotic Prescribing for Acute Respiratory Tract Infections

“…Intervention content was based on theories of behaviour change and particularly focused on increasing self-efficacy, one's belief that one can carry out a particular behaviour at a given time. 16,17 Clinicians reported being more confident in diagnosing an infection when using the CRP test and in explaining a nonprescribing decision to patients, and this appeared to be a result of training videos provided within interventions. Clinicians' expectations of the outcome of a consultation are also likely to have changed.…”

“…The STAR study evaluated a multifaceted educational intervention delivered through both online and outreach visit training, and was centred on communication skills. [16][17][18][19][20][21][22][23][24][25][26] Clinicians reported that communication skills training gave them an additional insight into their patients' agendas, which they felt would reduce future unnecessary consultations, but required an initial investment of longer consultations. The current study found that only a minority of clinicians specifically mentioned the advantage of the communication skills and most concentrated on the benefits of the patient booklet.…”

Plataforma Moodle na construção do conhecimento em Terapia Intensiva: estudo experimental

“…It is understandable that the student verbalizes comfort and safety in relation to scientific papers indicated by the professor regarding the content to be learned, because although there is a strong supply of online publications, in general, students still do not have security for interpret their findings. (18) Another analytical facility is the very ease of obtaining the article by the student, a lazy attitude. In this sense, the role of the teacher-tutor in Moodle deserves reflection, in that one can only monitor whether or not the student opened the text (which is possible via control tools) or provoke them with activities that may denote a real reading and reflection.…”

Factors affecting inappropriate prescription of antibiotics and the emergence of antibiotic resistance in patients in primary health care

“…As a possible solution to overcome this uncertainty they gave some recommendations such as better access to rapid diagnostic tests and the use of clinical guidelines. It has been shown that access to rapid diagnostic tests improve the use of antibiotics, as well as the respect of clinical guidelines which affects the rationalization of the use of antibiotics (19)(20)(21)(22). Some study participants cited the option of deferred prescribing of antibiotics as a possible solution in equivocal cases and scheduling follow-up examination after a short time period (3-4 days).…”