Primary care workshops can reduce and rationalize antibiotic prescribing

Abstract

We describe a controlled study comparing the effects on primary care prescribing in west Gloucestershire, UK, where antibiotic workshops were offered, with those in east Gloucestershire, where microbiology tutorials were given. The year-on-year changes in quantity and costs of antibiotics dispensed following general practice prescriptions were measured. There was no significant difference in the number of antibiotic items prescribed across the county, but the number of prescriptions for broad-spectrum agents (quinolones, cephalosporins and co-amoxiclav) declined by 15.4% in west Gloucestershire, compared with a 6.5% increase in east Gloucestershire (P: = 0.002). Use of narrow-spectrum antibiotics (penicillin V, trimethoprim and nitrofurantoin), whose use was encouraged, did not change in west Gloucestershire practices, but decreased by 12% in east Gloucestershire practices (P: = 0.003). There was increased use of clarithromycin and azithromycin in both groups of practices. Antibiotic workshops held in the primary care setting can rationalize antibiotic prescribing. This can reduce prescribing costs and selection pressure by broad-spectrum antimicrobial agents and, perhaps, go some way to reducing the development of resistance.

How Can National Antimicrobial Stewardship Interventions in Primary Care Be Improved? A Stakeholder Consultation

“…Yes [24,28] Yes-data publicly available but: varied provision of feedback; lack of national data/feedback on individual prescribing; varied use of prescriber codes…”

“…(1) Standardized quality improvement with tailored advice and action planning, [8,[20][21][22][23][24][26][27][28] were identified and are reported elsewhere [11]. 2 Twenty six nationally implemented AMS interventions were identified previously and are reported elsewhere [10].…”

“…Twenty-two interventions for primary care prescribers and eight for community pharmacy staff were identified, targeting on average 5.8 HCPs' behaviors [10]. A follow-up study identified barriers and facilitators to appropriate antibiotic prescribing in primary care and found nine interventions evaluated in the UK and shown effective at reducing antibiotic prescribing [11]; these included five research-only interventions [20][21][22][23][24] and four nationally available interventions: communication skills training [25], FeverPAIN clinical score [26], the TARGET toolkit [27], and the Chief Medical Officer's letters with prescribing feedback to the highest-prescribing practices [28]. Analyzing the behavioral content of the identified AMS interventions and comparing the extent to which they address relevant behaviors and key barriers and facilitators led to identification of potential changes to, or gaps to be addressed by, AMS interventions.…”

12 Arzt-Patienten-Kommunikation

“…40%), Schweden und Dänemark (je 50%) in die Gruppe, der "Wenigverordner". 21,22,23,24,25,26,27 Dabei besteht Konsens, dass die indizierte Antibiotikaverordnungsrate bei akutem Husten in der primärärztlichen Versorgung in westlichen Industrienationen bei 10-15% liegen müsste. 28,29 Die Abbildungen 1 und 2 zeigen Ergebnisse von Studien, in denen der Gesamtverbrauch an Antibiotika im ambulanten Bereich zwischen europäischen Ländern verglichen wurde.…”

Avoiding antibacterial overuse in primary care

“…In one study, small group tutorials for GPs aimed at rationalising antibacterial use reduced the use of broad-spectrum antibacterials and maintained the level of prescribing of narrow-spectrum antibacterials but did not reduce overall antibacterial usage 29. In another study, 1-day seminars reduced antibacterial prescribing for upper respiratory tract infections and acute otitis media, and increased appropriate prescribing for acute otitis media and tonsillopharyngitis 30…”