Implementing antibiotic stewardship in high-prescribing English general practices: a mixed-methods study

The British journal of general practice: the journal of the Royal College of General Practitioners

article

Sarah Tonkin-Crine¹  Monsey McLeod²  Aleksandra J Borek³  Anne Campbell⁴  Philip Anyanwu⁵  Céire Costelloe⁶  Michael Moore⁷  Benedict Hayhoe⁸  Koen B Pouwels⁹  Laurence SJ Roope⁹  Liz Morrell⁹  Susan Hopkins^1,10  Christopher C Butler³  Ann Sarah Walker^1,11 

[1] Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, National Institute for Health Research ,(NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford;NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, Centre for Medication Safety and Service Quality, Pharmacy Department, Imperial College Healthcare NHS Trust, London, and NIHR Imperial Patient Safety Translational Research Centre, Imperial College London;Nuffield Department of Primary Care Health Sciences, University of Oxford;NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London;Centre for Medical Education, School of Medicine, Cardiff University;Institute of Cancer Research;Primary Care Population Sciences and Medical Education, Faculty of Medicine, University of Southampton;Primary Care and Public Health, Imperial College London;Nuffield Department of Population Health, University of Oxford;UK Health Security Agency;Nuffield Department of Medicine, University of Oxford, Oxford, NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, and NIHR Oxford Biomedical Research Centre

关键词: antibiotic prescribing;    antimicrobial resistance;    antimicrobial stewardship;    behaviour change;    communication;    C-reactive protein;    delayed prescription;    implementation;    point-of-care testing;   

DOI  :  10.3399/BJGP.2022.0298

学科分类：卫生学

来源: Royal College of General Practitioners

【 摘 要 】

Background Trials have identified antimicrobial stewardship (AMS) strategies that effectively reduce antibiotic use in primary care. However, many are not commonly used in England. The authors co-developed an implementation intervention to improve use of three AMS strategies: enhanced communication strategies, delayed prescriptions, and point-of-care C-reactive protein tests (POC-CRPTs).Aim To investigate the use of the intervention in high-prescribing practices and its effect on antibiotic prescribing.Design and setting Nine high-prescribing practices had access to the intervention for 12 months from November 2019. This was primarily delivered remotely via a website with practices required to identify an ‘antibiotic champion’.Method Routinely collected prescribing data were compared between the intervention and the control practices. Intervention use was assessed through monitoring. Surveys and interviews were conducted with professionals to capture experiences of using the intervention.Results There was no evidence that the intervention affected prescribing. Engagement with intervention materials differed substantially between practices and depended on individual champions’ preconceptions of strategies and the opportunity to conduct implementation tasks. Champions in five practices initiated changes to encourage use of at least one AMS strategy, mostly POC-CRPTs; one practice chose all three. POC-CRPTs was used more when allocated to one person.Conclusion Clinicians need detailed information on exactly how to adopt AMS strategies. Remote, one-sided provision of AMS strategies is unlikely to change prescribing; initial clinician engagement and understanding needs to be monitored to avoid misunderstanding and suboptimal use.

【 授权许可】

Free