How can general practitioners reduce antibiotic prescribing in collaboration with their patients?

Mar, Chris Del; Hoffmann, Tammy; Bakhit, Mina

doi:10.31128/ajgp-07-21-6084

Cited by 6 publications

(6 citation statements)

References 27 publications

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“…They are tools to convey evidence-based information to clinicians with the goal of improving care quality and health outcomes [ 12 , 13 ]. Given the high rate of antibiotic prescribing in primary care, various antibiotic stewardship clinical strategies are recommended, including near-patient testing, delayed antibiotic prescribing (or “wait and see”) and shared decision making [ 14 – 17 ]. Some of these strategies require natural history information [ 18 , 19 ] and it is unknown if guidelines for common acute infections provide this information.…”

Section: Introductionmentioning

confidence: 99%

Information about the natural history of acute infections commonly seen in primary care: a systematic review of clinical practice guidelines

et al. 2022

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Background Many of the acute infections that are seen in primary care and sometimes managed with antibiotics are self-resolving and antibiotics may be unnecessary. Information about the natural history of these infections underpins antibiotic stewardship strategies such as delayed prescribing and shared decision making, yet whether it’s reported in guidelines is unknown. We examined, in clinical guidelines, the reporting of natural history information and relevant antibiotic stewardship strategies for acute infections commonly seen in primary care. Methods A systematic review of national and international guidelines (2010 onwards), available electronically, for managing acute infections (respiratory, urinary, or skin and soft tissue). We searched MEDLINE, CINAHL, EMBASE, TRIP, and GIN databases and websites of 22 guideline-publishing organisations. Results We identified 82 guidelines, covering 114 eligible infections. Natural history information was reported in 49 (59.8%) of the guidelines and 66 (57.9%) of the reported conditions, most commonly for respiratory tract infections. Quantitative information about the expected infection duration was provided for 63.5% (n = 42) of the infections. Delayed antibiotic prescribing strategy was recommended for 34.2% (n = 39) of them and shared decision making for 21% (n = 24). Conclusions Just over half of the guidelines for acute infections that are commonly managed in primary care and sometimes with antibiotics contained natural history information. As many of these infections spontaneously improve, this is a missed opportunity to disseminate this information to clinicians, promote antibiotic stewardship, and facilitate conversations with patients and informed decision making. Systematic review registration CRD42021247048

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Section: Introductionmentioning

confidence: 99%

Information about the natural history of acute infections commonly seen in primary care: a systematic review of clinical practice guidelines

et al. 2022

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“…Complex diagrams and numbers were not favoured as they were confusing to some. Tools such as patient information sheets and decision aids that contain relevant information can therefore assist patients in the decision process [ 13 , 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Addressing Antimicrobial Stewardship in Primary Care—Developing Patient Information Sheets Using Co-Design Methodology

et al. 2023

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Antibiotic resistance is a threat to global health, and inappropriate antibiotic use can be associated with adverse effects. Developing tools to encourage better communication between patients and general practitioners may reduce inappropriate use of antibiotics. The aim of the study was to develop shared decision support tools on common infections using a co-design methodology to address antimicrobial stewardship (AMS) in primary care. Three co-design/interview sessions were conducted with primary care providers and consumers between October 2019–April 2020 in Melbourne, Australia. Participants critiqued existing AMS tools, identified key elements required and optimised resulting prototypes. Primary care providers and consumers prioritised information to include in the AMS tools, such as when to see a doctor, management options, disease symptoms and cause of infection differently. However, both agreed content should be communicated in a plain, concise and logical manner, using inclusive and simple language accompanied by illustrations. Information sheets should be single-sided and A4-sized, appropriate for use before, during or after consultations. Co-design provided a collaborative forum to systematically design and develop products that meet the needs of both primary care providers and consumers. This resulted in the development of seven patient information sheets on common infections that encourage discussion of these infections, conservative management options and appropriate antibiotic use in primary care.

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“…Refers to healthcare professionals utilizing scientific evidence, clinical guidelines, and patient data to guide decisions on selecting, dosing, and timing antimicrobial treatment. Its objective is to enhance patient outcomes by reducing antimicrobial resistance and adverse effects, ensuring optimal treatment effectiveness 25 – 28 .…”

Section: Methodsmentioning

confidence: 99%

Point prevalence of evidence-based antimicrobial use among hospitalized patients in sub-Saharan Africa: a systematic review and meta-analysis

Boltena,

Wolde,

Hailu

et al. 2024

Sci Rep

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Excessive and improper use of antibiotics causes antimicrobial resistance which is a major threat to global health security. Hospitals in sub-Saharan Africa (SSA) has the highest prevalence of antibiotic use. This systematic review and meta-analysis aimed to determine the pooled point prevalence (PPP) of evidence-based antimicrobial use among hospitalized patients in SSA. Literature was retrieved from CINAHL, EMBASE, Google Scholar, PubMed, Scopus, and Web of Science databases. Meta-analysis was conducted using STATA version 17. Forest plots using the random-effect model were used to present the findings. The heterogeneity and publication bias were assessed using the I2 statistics and Egger’s test. The protocol was registered in PROSPERO with code CRD42023404075. The review was conducted according to PRISMA guidelines. A total of 26, 272 study participants reported by twenty-eight studies published from 10 countries in SSA were included. The pooled point prevalence of antimicrobial use in SSA were 64%. The pooled estimate of hospital wards with the highest antibiotic use were intensive care unit (89%). The pooled prevalence of the most common clinical indication for antibiotic use were community acquired infection (41%). The pooled point prevalence of antimicrobial use among hospitalized patients were higher in SSA. Higher use of antibiotics was recorded in intensive care units. Community acquired infection were most common clinical case among hospitalized patients. Health systems in SSA must design innovative digital health interventions to optimize clinicians adhere to evidence-based prescribing guidelines and improve antimicrobial stewardship.

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How can general practitioners reduce antibiotic prescribing in collaboration with their patients?

Cited by 6 publications

References 27 publications

Information about the natural history of acute infections commonly seen in primary care: a systematic review of clinical practice guidelines

Information about the natural history of acute infections commonly seen in primary care: a systematic review of clinical practice guidelines

Addressing Antimicrobial Stewardship in Primary Care—Developing Patient Information Sheets Using Co-Design Methodology

Point prevalence of evidence-based antimicrobial use among hospitalized patients in sub-Saharan Africa: a systematic review and meta-analysis

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