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

Author:

Tonkin-Crine SarahORCID,McLeod MonseyORCID,Borek Aleksandra JORCID,Campbell Anne,Anyanwu PhilipORCID,Costelloe CéireORCID,Moore MichaelORCID,Hayhoe BenedictORCID,Pouwels Koen BORCID,Roope Laurence SJORCID,Morrell LizORCID,Hopkins SusanORCID,Butler Christopher CORCID,Walker Ann SarahORCID

Abstract

BackgroundTrials 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).AimTo investigate the use of the intervention in high-prescribing practices and its effect on antibiotic prescribing.Design and settingNine 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’.MethodRoutinely 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.ResultsThere 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.ConclusionClinicians 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.

Publisher

Royal College of General Practitioners

Subject

Family Practice

Reference39 articles.

1. Public Health England (2020) English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) report 2019 to 2020 (Public Health England, London).

2. Exploring the appropriateness of antibiotic prescribing for common respiratory tract infections in UK primary care

3. Time trends and geographical variation in prescribing of antibiotics in England 1998–2017;Curtis;J Antimicrob Chemother,2019

4. Interventions to improve antibiotic prescribing practices in ambulatory care

5. Effectiveness of multifaceted educational programme to reduce antibiotic dispensing in primary care: practice based randomised controlled trial

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