Evaluation of a multimodal intervention to promote rational antibiotic use in primary care

Abstract Background Increasing antimicrobial resistance is a serious societal challenge affecting outpatient, inpatient and veterinary care. The German One-Health project, RAI (Rational use of Antibiotics via Information and Communication) addresses all three sectors. In the outpatient sector, General Practitioners (GPs) are the main prescribers of antibiotics and were therefore, targeted for this study. A multimodal intervention focusing on Acute Respiratory Tract infections (ARI) was designed and implemented. The aim of this study was to evaluate acceptance, rating and the self-reported impact of the intervention among GPs. Methods The intervention offered six tools: a GP training on rational antibiotic use, an app for self-monitoring, a leaflet and a set of posters (both for use as information materials in waiting rooms) and both digital and printed information prescriptions (material for ‘prescribing’ information instead of an antibiotic to the patient). The tools could be used according to individual preferences. The intervention was conducted between August 2016 and July 2017. Following the intervention, a three pages anonymous questionnaire was sent to all 271 participants. Items covered socio-demographic and professional background, use and judgement of the intervention tools (6 point Likert scale), impact of the intervention tools (4 point Likert scale). Results The response rate was 39% (n = 107). On average, respondents used 3.1 of the six available tools, with printed information prescriptions used most frequently (79%). Digital information prescriptions were used more frequently by men than by women (OR 2.8; 95% CI 1.16–7.24; p = 0.02). Eighty-seven percent of respondents stated that information prescriptions supported doctor-patient communication. In a comparison of the overall impression of the different intervention tools the GP training on rational antibiotic use was rated best (1.67 on a 6 point scale with 1 = highest, 6 = lowest) and most often noted as having had a “strong” or “very strong” impact on personal antibiotic prescribing behavior. Conclusions The multimodal intervention addressing education and communication was well accepted among GPs and could help in fostering rational use of antibiotics in primary care.

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Knowledge, Attitudes, and Reported Practices Among Obstetrician-Gynecologists in the USA Regarding Antibiotic Prescribing for Upper Respiratory Tract Infections

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/2005/405868 ◽

2005 ◽

Vol 13 (1) ◽

pp. 17-24 ◽

Cited By ~ 14

Author(s):

Shadi Chamany ◽

Jay Schulkin ◽

Charles E. Rose ◽

Laura E. Riley ◽

Richard E. Besser

Keyword(s):

Primary Care ◽

Respiratory Tract Infections ◽

Antibiotic Use ◽

Upper Respiratory Tract Infections ◽

Antibiotic Prescribing ◽

Upper Respiratory Tract ◽

Office Visits ◽

The Common ◽

Upper Respiratory ◽

Tract Infections

Background:Knowledge, attitudes, and practices regarding antibiotic prescribing for upper respiratory tract infections (URIs) have not been well described among obstetrician-gynecologists (OB/GYNs). This information is useful for determining whether an OB/GYN-specific program promoting appropriate antibiotic use would significantly contribute to the efforts to decrease inappropriate antibiotic use among primary care providers.Methods:An anonymous questionnaire asking about the treatment of URIs was sent to 1031 obstetrician-gynecologists.Results:The overall response rate was 46%. The majority of respondents (92%) were aware of the relationship between antibiotic use and antibiotic resistance, and respondents estimated that 5% of their patients had URI symptoms at their office visits. Overall, 56% of respondents reported that they would prescribe an antibiotic for uncomplicated bronchitis and 43% for the common cold. OB/GYNs with the fewest years of experience were less likely than those with the most years of experience to report prescribing for uncomplicated bronchitis (Odds ratio (OR) 0.46, 95% confidence interval (CI) 0.23 to 0.91) or the common cold (OR 0.44, CI 0.22 to 0.89). The majority of respondents (60%) believed that most patients wanted an antibiotic for URI symptoms, with male OB/GYNs being more likely than female OB/GYNs (OR 2.1, CI 1.2 to 3.8) to hold this belief. Both male OB/GYNs (OR 1.9, CI 1.1 to 3.4) and rural practitioners (OR 2.1, CI 1.1 to 4.0) were more likely to believe that it was hard to withhold antibiotics for URI symptoms because other physicians prescribe antibiotics for these symptoms. OB/GYNs who believed that postgraduate training prepared them well for primary care management were more likely than those who did not (OR 2.1, CI 1.1 to 4.2) to believe that they could reduce antibiotic prescribing without reducing patient satisfaction.Conclusion:Multiple demographic factors affect attitudes and reported practices regarding antibiotic prescribing. However, in view of the low proportion of office visits for URIs, an OB/GYN-specific program is not warranted.

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Rational Use of Antibiotics – A Point Prevalence Study Carried out at a Tertiary Hospital in South-South Nigeria

International Journal of TROPICAL DISEASE & Health ◽

10.9734/ijtdh/2020/v41i1430352 ◽

2020 ◽

pp. 39-47

Author(s):

Okechukwu Chioma

Keyword(s):

Antibiotic Resistance ◽

Antibiotic Use ◽

Tertiary Hospital ◽

Point Prevalence ◽

Prescribing Patterns ◽

Prevalence Study ◽

Antibiotic Prescribing ◽

Point Prevalence Study ◽

Rational Use ◽

Rational Use Of Antibiotics

Introduction: The burden of antibiotic resistance in the hospitals and communities is progressively worsening hence the critical need to put into practice all the key components of rational use of antibiotics in our daily patient interactions. This paper aims to highlight the problem of antibiotic resistance, the importance of rational use of antibiotics and to show an on the spot sketch of the antibiotic use pattern among in-patients in the children wards in a tertiary hospital. Methodology: A brief review of the existing literature on antibiotic resistance and the rational use of antibiotics was done. A one-day cross-sectional point prevalence study was conducted in the children wards in UPTH and all children receiving antibiotics on that day, identified. The prevalence of antibiotic use was determined by dividing the number of inpatients on antibiotics at the time of the survey by the total number of patients on admission. Data were presented in percentages using pie and bar charts. Results: There were a total of 40 children on admission in the paediatric wards with a Male: Female ratio of 1.2:1. 34 (85.0%) of the children on admission were receiving at least one antibiotic. The most common route of administration of the antibiotics was the intravenous route (94.1%). The five most commonly prescribed antibiotics in the children medical wards and the emergency ward were Ceftriaxone, Gentamycin, Cefuroxime, Metronidazole and Crystalline penicillin, while the five most common antibiotics prescribed in the special care baby unit were Gentamycin, Ceftazidime, Ceftriaxone, Metronidazole and Ofloxacin. Only 10 (29.4%) out of children receiving antibiotics had a microbiology culture result available, and 4 were receiving antibiotics in line with the culture sensitivity pattern. Two (5.9%) children had a multidrug-resistant infection. Conclusion: This study showed a high prevalence of antibiotic use among inpatients and low utilization of microbiology culture results in the choice of antibiotics in a tertiary hospital in South-south Nigeria. Antibiotic prescribing patterns among healthcare workers should be improved upon by training and retraining of personnel as well as strict adherence to antibiotic prescription guidelines.

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Rational Antibiotic Use by Ordinary People in Jakarta

MITRA Jurnal Pemberdayaan Masyarakat ◽

10.25170/mitra.v3i1.502 ◽

2019 ◽

Vol 3 (1) ◽

pp. 73-82

Author(s):

Sherly Tandi Arrang ◽

Fonny Cokro ◽

Erlia Anggrainy Sianipar

Keyword(s):

Antibiotic Use ◽

Ordinary People ◽

Self Medication ◽

Rational Use ◽

Resistance Risk ◽

Inappropriate Use ◽

Runny Nose ◽

Life Threatening ◽

Rational Use Of Antibiotics ◽

Rational Antibiotic Use

Self-medication is defined as self treatment and self-diagnose for conditions such as cough, flu, fever, pain, stomach ulcers, worms, diarrhea, rash, and some other minor illnesses. Based on the data from Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan RI (2013), there were 103.860 of 294.959 households (35,2%) in Indonesia which store medicines for selfmedication (including 35,7% “Obat Keras” or “Gevaarlijk” and 27,8% antibiotics). DKI Jakarta (56,4%) is the highest province with respect to stored medicines. Some studies have found that 40-62% of antibiotics are not used properly. The inappropriate use of antibiotics can lead to antibiotic resistance risk and can be life-threatening for people in every part of the world. To address this problem, this community service was conducted to provide information about selfmedication of influenza and cough illness and to improve people’s knowledge in the proper use of antibiotics. Lecturing was chosen as the method for explaining the rational use of antibiotics and participants were requested to fill out a questionnaire. This activity was attended by 34 participants (and 32 participants filled out the questionnaire). About 13 participants (40,6%) provided correct answers to questions on the proper use of antibiotics. Twenty six participants (81,25%) said they had previously used antibiotics, 14 of them (53,85%) admitted to purchasing antibiotics without a prescription. Antibiotics are taken to treat symptoms such as runny nose, cough, sore throat, fever, and other conditions. A total of 7 participants (26,92%) admitted taking antibiotics with dosage modification and 8 participants (30,77%) switched one type of antibiotics with another type of antibiotics. Based on the results, we concluded that people did not have sufficient knowledge about the rational use of antibiotics. We suggested that counseling about the proper use of antibiotics should be improved.

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Antibiotic prescribing for acute, non-complicated infections in primary care in Germany: baseline assessment in the cluster randomized trial ARena

BMC Infectious Diseases ◽

10.1186/s12879-021-06571-0 ◽

2021 ◽

Vol 21 (1) ◽

Cited By ~ 1

Author(s):

Regina Poss-Doering ◽

Dorothea Kronsteiner ◽

Martina Kamradt ◽

Edith Andres ◽

Petra Kaufmann-Kolle ◽

...

Keyword(s):

Primary Care ◽

Antimicrobial Resistance ◽

Respiratory Tract ◽

General Practitioners ◽

Respiratory Tract Infections ◽

Reference Group ◽

Antibiotic Prescribing ◽

Tract Infections ◽

Rational Use Of Antibiotics ◽

To Receive

Abstract Background Antimicrobial resistance is fueled by inappropriate use of antibiotics. Global and national strategies support rational use of antibiotics to retain treatment options and reduce resistance. In Germany, the ARena project (Sustainable reduction of antibiotic-induced antimicrobial resistance) intended to promote rational use of antibiotics for acute non-complicated infections by addressing network-affiliated physicians, primary care teams and patients through multiple interacting interventions. The present study documented patterns of antibiotic prescribing for patients with acute non-complicated infections who consulted a physician in these networks at the start of the ARena project. It explored variation across subgroups of patients and draws comparisons to prescribing patterns of non-targeted physicians. Methods This retrospective cross-sectional analysis used mixed logistic regression models to explore factors associated with the primary outcome, which was the percentage of patient cases with acute non-complicated respiratory tract infections consulting primary care practices who were treated with antibiotics. Secondary outcomes concerned the prescribing of different types of antibiotics. Descriptive methods were used to summarize the data referring to targeted physicians in primary care networks, non-targeted physicians (reference group), and patient subgroups. Results Overall, antibiotic prescribing rates were 32.0% in primary care networks and 31.7% in the reference group. General practitioners prescribed antibiotics more frequently than other medical specialist groups (otolaryngologists vs. General practitioners OR = 0.465 CI = [0.302; 0.719], p < 0.001, pediatricians vs. General practitioners: OR = 0.369 CI = [0.135; 1.011], p = 0.053). Quinolone prescribing rates were 9.9% in primary care networks and 8.1% in reference group. Patients with comorbidities had a higher likelihood of receiving an antibiotic and quinolone prescription and were less likely to receive a guideline-recommended substance. Younger patients were less likely to receive antibiotics (OR = 0.771 CI = [0.636; 0.933], p = 0.008). Female gender was more likely to receive an antibiotic prescription (OR = 1.293 CI = [1.201, 1.392], p < 0.001). Conclusion This study provided an overview of observed antibiotic prescribing for acute non-complicated respiratory tract infections in German primary care at the start of the ARena project. Findings indicate potential for improvement and will serve as comparator for the post-interventional outcome evaluation to facilitate describing of potential changes.

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A pragmatic randomized trial of a primary care antimicrobial stewardship intervention in Ontario, Canada

BMC Family Practice ◽

10.1186/s12875-021-01536-3 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Warren McIsaac ◽

Sahana Kukan ◽

Ella Huszti ◽

Leah Szadkowski ◽

Braden O’Neill ◽

...

Keyword(s):

Primary Care ◽

Antimicrobial Stewardship ◽

Care Provider ◽

Primary Care Provider ◽

Antibiotic Use ◽

Primary Care Providers ◽

Audit And Feedback ◽

Antibiotic Prescribing ◽

Care Providers ◽

Tract Infections

Abstract Background More than 90% of antibiotics are prescribed in primary care, but 50% may be unnecessary. Reducing unnecessary antibiotic overuse is needed to limit antimicrobial resistance. We conducted a pragmatic trial of a primary care provider-focused antimicrobial stewardship intervention to reduce antibiotic prescriptions in primary care. Methods Primary care practitioners from six primary care clinics in Toronto, Ontario were assigned to intervention or control groups to evaluate the effectiveness of a multi-faceted intervention for reducing antibiotic prescriptions to adults with respiratory and urinary tract infections. The intervention included provider education, clinical decision aids, and audit and feedback of antibiotic prescribing. The primary outcome was total antibiotic prescriptions for these infections. Secondary outcomes were delayed prescriptions, prescriptions longer than 7 days, recommended antibiotic use, and outcomes for individual infections. Generalized estimating equations were used to estimate treatment effects, adjusting for clustering by clinic and baseline differences. Results There were 1682 encounters involving 54 primary care providers from January until May 31, 2019. In intervention clinics, the odds of any antibiotic prescription was reduced 22% (adjusted Odds Ratio (OR) = 0.78; 95% Confidence Interval (CI) = 0.64.0.96). The odds that a delay in filling a prescription was recommended was increased (adjusted OR=2.29; 95% CI=1.37, 3.83), while prescription durations greater than 7 days were reduced (adjusted OR=0.24; 95% CI=0.13, 0.43). Recommended antibiotic use was similar in control (85.4%) and intervention clinics (91.8%, p=0.37). Conclusions A community-based, primary care provider-focused antimicrobial stewardship intervention was associated with a reduced likelihood of antibiotic prescriptions for respiratory and urinary infections, an increase in delayed prescriptions, and reduced prescription durations. Trial registration clinicaltrials.gov (NCT03517215).

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Curriculum update for future pharmacy technicians to enhance rational use of antibiotics in Turkey

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.592 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

O Karadag Caman ◽

S Uner ◽

B Arica Yegin ◽

H Ozcebe

Keyword(s):

Public Health ◽

Healthcare Professionals ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Rational Use ◽

Leading Role ◽

Pharmacy Technicians ◽

Rational Use Of Antibiotics ◽

Undergraduate Programs ◽

Rational Antibiotic Use

Abstract Background Antimicrobial resistance (AMR) is one of the most important global public health issues and training of healthcare professionals and the public needs to be an integral part of all AMR efforts. In 2015, four out of six countries with the highest antibiotic consumption rate in the world were low and middle-income countries, where Turkey was reported as the country with the highest consumption. Methods This paper aims to present a new undergraduate course entitled “Rational use of antibiotics”, specifically designed for pharmacy technician students to increase their awareness on AMR and to equip them with knowledge and skills in promoting rational antibiotic use. The curriculum update was part of a larger international project, supported by the Erasmus+ KA2 Strategic Partnership Program (Project no: 2015-1-TR01-KA204-022393). Results Pharmacy technicians are among the most critical health professionals regarding rational antibiotic use because they can play a significant role in educating potential antibiotic users and have a multiplier effect in disseminating evidence-based knowledge. The 16-week long undergraduate course was designed by pharmacy and public health faculty with a multidisciplinary approach, focusing on topics such as epidemiology and control of communicable diseases, antibiotics, AMR and its public health consequences, legal regulations and medical practice regarding rational antibiotic use, as well as principles and methods of health promotion and health education. Conclusions Quantitative and qualitative evaluation of the newly introduced undergraduate course on the rational use of antibiotics showed promising results, which indicate that designing specific courses for health professions students to combat AMR can be more widely practiced in countries with high antibiotic consumption. Public health academics can take a leading role and responsibility in the design of such multidisciplinary courses for undergraduate programs in health care. Key messages Specific courses on rational use of antibiotics can be effective in changing knowledge, attitude, and behaviors of healthcare professionals, and consecutively the general public in combatting AMR. Public health academics can take a leading role and responsibility in design of such multidisciplinary courses for undergraduate programs in health care.

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Does cash payment influence a GP’s decision to prescribe antibiotics?

10.33178/boolean.2010.28 ◽

2010 ◽

pp. 125-132

Author(s):

Marion Murphy

Keyword(s):

Acute Otitis Media ◽

Acute Bronchitis ◽

Antibiotic Use ◽

Health Concern ◽

Antibiotic Prescribing ◽

Cold Sore ◽

Cash Payment ◽

The Common ◽

Tract Infections ◽

Rational Use Of Antibiotics

Antimicrobial resistance is a major public health concern and one of the primary factors contributing to resistance is the unnecessary use of antimicrobials. Many countries have developed strategies in order to promote the rational use of antibiotics. Ireland is only one of three European countries where outpatient antibiotic use is increasing, at a rate of 3% per year since 2000. The majority of antibiotic prescribing is conducted by General Practitioners (GPs) in the community, and wide variation is known to exist. The volume of antibiotics prescribed that are unnecessary in the community is unknown but it is believed that a number are used to treat minor respiratory tract infections. These conditions such as the common cold, sore throat, acute otitis media and acute bronchitis have no compelling evidence to support the use of antibiotics in their treatment. There are many external (non-clinical) factors that influence a GP’s decision to prescribe, ...

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Tackling Anti-microbial Resistance: An Ethical Framework for Rational Antibiotic Use

Ethics and Drug Resistance: Collective Responsibility for Global Public Health - Public Health Ethics Analysis ◽

10.1007/978-3-030-27874-8_20 ◽

2020 ◽

pp. 321-344

Author(s):

Jasper Littmann ◽

Annette Rid ◽

Alena Buyx

Keyword(s):

Antibiotic Use ◽

Community Acquired Pneumonia ◽

Ethical Framework ◽

Policy Makers ◽

Rational Use ◽

Acceptable Risks ◽

Ethical Conflicts ◽

Patients At Risk ◽

Rational Use Of Antibiotics ◽

Rational Antibiotic Use

Abstract To reduce the effect of antimicrobial resistance and preserve antibiotic effectiveness, clinical practice guidelines and health policy documents call for the “rational use” of antibiotics that aims to avoid unnecessary or minimally effective antibiotic prescriptions. In this paper, we show that rational use programmes can lead to ethical conflicts because they place some patients at risk of harm – for example, a delayed switch to second-line antibiotics for community-acquired pneumonia is associated with increased fatality rates. Implementing the rational use of antibiotics can therefore lead to conflicts between promoting patients’ clinical interests and preserving antibiotic effectiveness for future use. The resulting ethical dilemma for clinicians, patients and policy makers has so far not been adequately addressed. We argue that existing guidance for acceptable risks in clinical research can help to define risk thresholds for the rational use of antibiotics. We develop an ethical framework that allows clinicians and policy-makers to evaluate policies for rational antibiotic use in six practical steps.

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Antibiotic Prescribing for Acute, Non-Complicated Infections in Primary Care in Germany: Baseline Assessment of in the Cluster Randomized Trial ARena

10.21203/rs.3.rs-329011/v1 ◽

2021 ◽

Author(s):

Regina Poss-Doering ◽

Dorothea Kronsteiner ◽

Martina Kamradt ◽

Edith Andres ◽

Petra Kaufmann-Kolle ◽

...

Keyword(s):

Primary Care ◽

General Practitioners ◽

Antibiotic Prescription ◽

Prescribing Patterns ◽

Antibiotic Prescribing ◽

Reference Groups ◽

Rational Use ◽

Prescription Rates ◽

Rational Use Of Antibiotics ◽

To Receive

Abstract BackgroundAntimicrobial resistance is fueled by inappropriate use of antibiotics. Global and national strategies support rational use of antibiotics to retain treatment options and reduce resistance. In Germany, the ARena project (Sustainable reduction of antibiotic-induced antimicrobial resistance) intended to promote rational use of antibiotics for acute non-complicated infections by addressing network-affiliated physicians, primary care teams and patients through multiple interacting interventions. The present study documented patterns of antibiotic prescribing for patients with acute non-complicated infections who consulted a physician in these networks at the start of the ARena project. It explored variation across subgroups of patients and draws comparisons to prescribing patterns of non-targeted physicians. MethodsThis retrospective cross-sectional analysis used mixed logistic regression models to explore factors associated with the primary outcome, which was the proportion of patients with acute non-complicated infections consulting primary care practices who received an antibiotic prescription. Secondary outcomes concerned the prescription of different types of antibiotics. Descriptive methods were used to summarize the data referring to targeted physicians in primary care networks, non-targeted physicians (reference groups), and patient subgroups. ResultsOverall, antibiotic prescription rates were 31.7% in reference groups and 32.0% in primary care networks. General practitioners prescribed antibiotics more frequently than other medical specialist groups (otolaryngologists vs. General practitioners OR=0.465 CI=[0.302; 0.719], p<0.001, pediatricians vs. General practitioners: OR=0.369 CI=[0.135; 1.011], p=0.053). Quinolone prescription rates were 8.1% in reference groups and 9.9% in primary care networks. Patients with comorbidities had a higher likelihood of receiving an antibiotic and quinolone prescription and were less likely to receive a guideline-recommended substance. Younger patients were less likely to receive antibiotics (OR=0.771 CI=[0.636; 0.933], p=0.008). Female gender was associated with higher rates of antibiotic prescriptions (OR=1.293 CI=[1.201, 1.392], p<0.001).Conclusion At the start of the ARena project, observed antibiotic prescription rates for acute non-complicated infections showed room for improvement. This clearly supports the need for the ARENA-Project.

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Does diagnostic uncertainty increase antibiotic prescribing in primary care?

npj Primary Care Respiratory Medicine ◽

10.1038/s41533-021-00229-9 ◽

2021 ◽

Vol 31 (1) ◽

Author(s):

Dan Wang ◽

Chaojie Liu ◽

Xinping Zhang ◽

Chenxi Liu

Keyword(s):

Primary Care ◽

Antibiotic Use ◽

Antibiotic Prescribing ◽

Upper Respiratory Tract ◽

Acute Tonsillitis ◽

Diagnostic Uncertainty ◽

Patient Tolerance ◽

Prescribing Behaviour ◽

Tolerance Of Uncertainty ◽

Tract Infections

AbstractThis study aimed to determine the association between factors relevant to diagnostic uncertainty and physicians’ antibiotic-prescribing behaviour in primary care. A questionnaire survey was conducted on 327 physicians that measured their diagnostic ability, perceived frequency of diagnostic uncertainty, tolerance, and perceived patient tolerance of uncertainty. Physician antibiotic-prescribing behaviours were assessed based on their prescriptions (n = 207,804) of three conditions: upper respiratory tract infections (URTIs, antibiotics not recommended), acute tonsillitis (cautious use of antibiotics), and pneumonia (antibiotics recommended). A two-level logistic regression model determined the association between diagnostic uncertainty factors and physician antibiotic prescribing. Physicians perceived a higher frequency of diagnostic uncertainty resulting in higher antibiotic use for URTIs and less antibiotic use for pneumonia. Higher antibiotic use for acute tonsillitis was related to a low tolerance of uncertainty of physicians and patients. This study suggests that reducing diagnostic uncertainty and improving physician and patient uncertainty management could reduce antibiotic use.

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