scholarly journals Development of an intervention to support the implementation of evidence-based strategies for optimising antibiotic prescribing in general practice

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Aleksandra J. Borek ◽  
Anne Campbell ◽  
Elle Dent ◽  
Michael Moore ◽  
Christopher C. Butler ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Focus Groups ◽  
Health Professionals ◽  
Skills Training ◽  
Antibiotic Use ◽  
Behavioural Intervention ◽  
Antibiotic Prescribing ◽  
Evidence Based ◽  
Think Aloud

Abstract Background Trials show that antimicrobial stewardship (AMS) strategies, including communication skills training, point-of-care C-reactive protein testing (POC-CRPT) and delayed prescriptions, help optimise antibiotic prescribing and use in primary care. However, the use of these strategies in general practice is limited and inconsistent. We aimed to develop an intervention to enhance uptake and implementation of these strategies in primary care. Methods We drew on the Person-Based Approach to develop an implementation intervention in two stages. (1) Planning and design: We defined the problem in behavioural terms drawing on existing literature and conducting primary qualitative research (nine focus groups) in high-prescribing general practices. We identified ‘guiding principles’ with intervention objectives and key features and developed logic models representing intended mechanisms of action. (2) Developing the intervention: We created prototype intervention materials and discussed and refined these with input from 13 health professionals and 14 citizens in two sets of design workshops. We further refined the intervention materials following think-aloud interviews with 22 health professionals. Results Focus groups highlighted uncertainties about how strategies could be used. Health professionals in the workshops suggested having practice champions, brief summaries of each AMS strategy and evidence supporting the AMS strategies, and they and citizens gave examples of helpful communication strategies/phrases. Think-aloud interviews helped clarify and shorten the text and user journey of the intervention materials. The intervention comprised components to support practice-level implementation: antibiotic champions, practice meetings with slides provided, and an ‘implementation support’ website section, and components to support individual-level uptake: website sections on each AMS strategy (with evidence, instructions, links to electronic resources) and material resources (patient leaflets, POC-CRPT equipment, clinician handouts). Conclusions We used a systematic, user-focussed process of developing a behavioural intervention, illustrating how it can be used in an implementation context. This resulted in a multicomponent intervention to facilitate practice-wide implementation of evidence-based strategies which now requires implementing and evaluating. Focusing on supporting the uptake and implementation of evidence-based strategies to optimise antibiotic use in general practice is critical to further support appropriate antibiotic use and mitigate antimicrobial resistance.

scholarly journals Is sharing the TARGET respiratory tract infection leaflet feasible in routine general practice to improve patient education and appropriate antibiotic use? A mixed methods study in England with patients and healthcare professionals

2020 ◽  
Vol 21 (3) ◽  
pp. 97-107
Author(s):  
Charlotte V Eley ◽  
Donna M Lecky ◽  
Catherine V Hayes ◽  
Cliodna AM McNulty
Keyword(s):  
General Practice ◽  
Patient Education ◽  
Respiratory Tract ◽  
Focus Groups ◽  
Antibiotic Use ◽  
Service Evaluation ◽  
Antibiotic Prescribing ◽  
Illness Duration ◽  
Antibiotic Effect ◽  
Tract Infections

Background: Patient education on treatment choices for common respiratory tract infections (RTIs) is important to encourage appropriate antibiotic use. Evidence shows that use of leaflets about RTIs can help reduce antibiotic prescribing. TARGET leaflets facilitate patient–clinician communication in consultations. Aim: To explore patient, healthcare professional (HCP) and general practice (GP) staff views on the current Treating Your Infection (TYI)-RTI leaflet and proposed new ‘antibiotic effect’ column aimed at sharing information on the limited effect antibiotics have on the duration of RTIs. Methods: Service evaluation underpinned by Com-B behavioural framework, using patient and HCP questionnaires, and GP staff interviews/focus groups. Results: Patients completed 83 questionnaires in GP waiting rooms. A lack of patient understanding about usual illness duration influenced their use of antibiotics for some RTIs. Patients provided positive feedback about the leaflet, reporting it increased their capability to self-care, re-consult when necessary and increase understanding of illness duration. Patients indicated they would value information on the difference antibiotics can make to illness duration. In total, 43 HCP questionnaires were completed and 16 GP staff participated in interviews/focus groups. Emerging themes included: barriers and facilitators to leaflet use; modifications; and future dissemination of the leaflet. GP staff stated that the ‘antibiotic effect’ column should not be included in the leaflet. Conclusion: Patient education around usual illness duration, side effects of antibiotics and back-up prescriptions gives patients a greater control of their infection management. As GP staff opposed the extra information about benefits of antibiotics on illness duration, this will not be added.

scholarly journals A Review of Evidence-Based Recommendations for Pericoronitis Management and a Systematic Review of Antibiotic Prescribing for Pericoronitis among Dentists: Inappropriate Pericoronitis Treatment Is a Critical Factor of Antibiotic Overuse in Dentistry

2021 ◽  
Vol 18 (13) ◽  
pp. 6796
Author(s):  
Jan Schmidt ◽  
Martina Kunderova ◽  
Nela Pilbauerova ◽  
Martin Kapitan
Keyword(s):  
Systematic Review ◽  
Local Therapy ◽  
Critical Factor ◽  
Antibiotic Use ◽  
Narrative Review ◽  
Antibiotic Prescribing ◽  
Evidence Based ◽  
Antibiotic Overuse ◽  
Clinically Significant

This work provides a narrative review covering evidence-based recommendations for pericoronitis management (Part A) and a systematic review of antibiotic prescribing for pericoronitis from January 2000 to May 2021 (Part B). Part A presents the most recent, clinically significant, and evidence-based guidance for pericoronitis diagnosis and proper treatment recommending the local therapy over antibiotic prescribing, which should be reserved for severe conditions. The systematic review includes publications analyzing sets of patients treated for pericoronitis and questionnaires that identified dentists' therapeutic approaches to pericoronitis. Questionnaires among dentists revealed that almost 75% of them prescribed antibiotics for pericoronitis, and pericoronitis was among the top 4 in the frequency of antibiotic use within the surveyed diagnoses and situations. Studies involving patients showed that antibiotics were prescribed to more than half of the patients with pericoronitis, and pericoronitis was among the top 2 in the frequency of antibiotic use within the monitored diagnoses and situations. The most prescribed antibiotics for pericoronitis were amoxicillin and metronidazole. The systematic review results show abundant and unnecessary use of antibiotics for pericoronitis and are in strong contrast to evidence-based recommendations summarized in the narrative review. Adherence of dental professionals to the recommendations presented in this work can help rapidly reduce the duration of pericoronitis, prevent its complications, and reduce the use of antibiotics and thus reduce its impact on patients' quality of life, healthcare costs, and antimicrobial resistance development.

scholarly journals Implementing interventions to reduce antibiotic use: a qualitative study in high-prescribing practices

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Aleksandra J. Borek ◽  
◽  
Anne Campbell ◽  
Elle Dent ◽  
Christopher C. Butler ◽  
...  
Keyword(s):  
Focus Groups ◽  
Point Of Care ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Focus Group Study ◽  
Clinical Uncertainty ◽  
Reactive Protein ◽  
Clinical Tools ◽  
The Many

Abstract Background Trials have shown that delayed antibiotic prescriptions (DPs) and point-of-care C-Reactive Protein testing (POC-CRPT) are effective in reducing antibiotic use in general practice, but these were not typically implemented in high-prescribing practices. We aimed to explore views of professionals from high-prescribing practices about uptake and implementation of DPs and POC-CRPT to reduce antibiotic use. Methods This was a qualitative focus group study in English general practices. The highest antibiotic prescribing practices in the West Midlands were invited to participate. Clinical and non-clinical professionals attended focus groups co-facilitated by two researchers. Focus groups were audio-recorded, transcribed verbatim and analysed thematically. Results Nine practices (50 professionals) participated. Four main themes were identified. Compatibility of strategies with clinical roles and experience – participants viewed the strategies as having limited value as ‘clinical tools’, perceiving them as useful only in ‘rare’ instances of clinical uncertainty and/or for those less experienced. Strategies as ‘social tools’ – participants perceived the strategies as helpful for negotiating treatment decisions and educating patients, particularly those expecting antibiotics. Ambiguities – participants perceived ambiguities around when they should be used, and about their impact on antibiotic use. Influence of context – various other situational and practical issues were raised with implementing the strategies. Conclusions High-prescribing practices do not view DPs and POC-CRPT as sufficiently useful ‘clinical tools’ in a way which corresponds to the current policy approach advocating their use to reduce clinical uncertainty and improve antimicrobial stewardship. Instead, policy attention should focus on how these strategies may instead be used as ‘social tools’ to reduce unnecessary antibiotic use. Attention should also focus on the many ambiguities (concerns and questions) about, and contextual barriers to, using these strategies that need addressing to support wider and more consistent implementation.

scholarly journals Promoting rational antibiotic prescribing for non-complicated infections: Understanding social influence in primary care networks in Germany

2020 ◽  
Author(s):  
Regina Poss-Doering ◽  
Martina Kamradt ◽  
Katharina Glassen ◽  
Edith Andres ◽  
Petra Kaufmann-Kolle ◽  
...  
Keyword(s):  
Social Support ◽  
Primary Care ◽  
Social Influence ◽  
Health Professionals ◽  
Best Practice ◽  
Antibiotic Prescribing ◽  
Care Providers ◽  
Self Reflection ◽  
Physician Health ◽  
Improvement Programs

Abstract Background Primary care networks in Germany are formalized regional collaborations of physicians and other healthcare providers. Common goals are optimized healthcare processes and services for patients, enhanced communication, agency for professional concerns and strengthened economic power. In the ARena study (Sustainable reduction of antibiotic-induced antimicrobial resistance), 14 primary care networks in two federal German states aimed to promote appropriate antibiotics use for acute non-complicated infections by fostering awareness and understanding. Factors related to the role of primary care networks were to be identified. Methods For this study, audio-recorded telephone interviews were conducted with physicians, non-physician health professionals and stakeholder representatives. Pseudonymized verbatim transcripts were coded using thematic analysis. In-depth analysis was based on the inductive categories ‘social support’, ‘social learning’, ‘social normative pressures’ and ‘social contagion’ to reflect social influence processes. Data generated through a survey with physicians and non-physician health professionals were analyzed descriptively to foster understanding of the networks’ potential impact on antibiotic prescribing. Results Social influence processes proved to be relevant regarding knowledge transfer, manifestation of best-practice care and self-reflection. Peer communication was seen as great asset, main reason for membership and affirmative for own perspectives. All interviewed physicians (n=27) considered their network to be a strong support factor for daily routines, introduction of new routines, and continuity of care. They utilized network-offered training programs focusing on best practice guideline-oriented use of antibiotics and considered their networks supportive in dealing with patient expectations. A shared attitude combined with ARena intervention components facilitated reflected management of antibiotic prescribing. Non-physician health professionals (n=11) also valued network peer exchange. They assumed their employers joined networks to offer improved and continuous care. Stakeholders (n=7) expected networks and their members to be drivers for care optimization. Conclusion Primary care networks play a crucial role in providing a platform for professional peer exchange, social support and reassurance. With regards to their impact on antibiotic prescribing for acute non-complicated infections, networks seem to facilitate and amplify quality improvement programs by providing a platform for refreshing awareness, knowledge and self-reflection among care providers. They are well suited to promote a rational use of antibiotics.

scholarly journals Conceptions of the professionals about their attributions in the Expanded Nucleus of Family Health

Psico-USF ◽  
2019 ◽  
Vol 24 (4) ◽  
pp. 661-671
Author(s):  
Meyrielle Belotti ◽  
Alexandra Iglesias ◽  
Luziane Zacché Avellar
Keyword(s):  
Primary Care ◽  
Qualitative Research ◽  
Content Analysis ◽  
Data Collection ◽  
Focus Groups ◽  
Health Professionals ◽  
Family Health ◽  
Work Processes ◽  
The Family ◽  
Specialized Care

Abstract The article aims to analyze the conceptions conferred by the health professionals that compose the Expanded Nuclei of Family Health (NASF) on their work assignments. This is a qualitative research, in which was used, for the data collection, eight focus groups, with a total of 43 participants. The data were submitted to content analysis. The results outlined the following categories: integrating NASF work with the Family Health Teams (ESF); developing specialized care; promoting intersectionality; contributing to the promotion of teamwork in Primary Care (AB) and strengthening AB. The study indicates the importance of a better understanding of the functions of the NASF, so that it does not restrict the opportunity to perform specialized care in AB. It is pointed out, the need for adjustments in the work processes of the ESF, in order to enable the shared work in the AB.

scholarly journals Understanding antibiotic prophylaxis prescribing in pediatric surgical specialties

2020 ◽  
Vol 41 (6) ◽  
pp. 666-671
Author(s):  
Sara M. Malone ◽  
Natalie S. Seigel ◽  
Jason G. Newland ◽  
Jacqueline M. Saito ◽  
Virginia R. McKay
Keyword(s):  
Focus Groups ◽  
Antibiotic Prophylaxis ◽  
Scientific Evidence ◽  
Implementation Strategies ◽  
Interventional Cardiology ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Health Crisis ◽  
Poor Outcomes

AbstractBackground:Overuse of antibiotics has caused secondary poor outcomes and has led to a current rate of antibiotic resistant infections that constitutes a public health crisis. In pediatric surgical specialties, children continue to receive unnecessary antibiotics.Objective:To understand the factors that contribute to pediatric surgeons’ decisions regarding the use of perioperative antibiotic prophylaxis.Methods:Focus groups included pediatric proceduralists/surgeons from the following specialties: interventional cardiology, otolaryngology, orthopedic surgery, cardiothoracic surgery, and general surgery.Results:A total of 23 surgeons with a median of 9 years of experience (range, 0.5–29 years) participated in the focus groups that lasted 30–90 minutes each. Five themes emerged influencing beliefs about antibiotic prescribing practices: (1) reliance on previous experience and early education, (2) balancing antibiotic use with risk of infection, (3) uncertainty about the state of the scientific evidence, (4) understanding importance of communication and team collaboration, and (5) a prevalence of hospital-level concerns.Conclusions:Surgeons describe a complex set of factors that impact their antibiotic prescribing in pediatric surgical cases. They reported initial, but not ongoing, training and a use of individual weight of risk and benefit as a major dictator of prescribing practices. Antimicrobial stewardship programs should work with surgeons to develop acceptable implementation strategies to optimize antibiotic prescribing.

scholarly journals Severe Asthma Toolkit: an online resource for multidisciplinary health professionals—needs assessment, development process and user analytics with survey feedback

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e032877
Author(s):  
Steven Maltby ◽  
Peter G Gibson ◽  
Helen K Reddel ◽  
Lorraine Smith ◽  
Peter A B Wark ◽  
...  
Keyword(s):  
Needs Assessment ◽  
Severe Asthma ◽  
Health Professionals ◽  
Healthcare Professionals ◽  
Reference Group ◽  
Asthma Management ◽  
Web Design ◽  
Skills Training ◽  
Evidence Based ◽  
Internet Resource

ObjectivesSevere asthma imposes a significant burden on individuals, families and the healthcare system. New treatment and management approaches are emerging as effective options for severe asthma. Translating new knowledge to multidisciplinary healthcare professionals is a priority. We developed ‘The Severe Asthma Toolkit’(https://toolkit.severeasthma.org.au) to increase awareness of severe asthma, provide evidence-based resources and support decisionmaking by healthcare providers.SettingRoundtable discussions and a survey of Australians clinicians were conducted to determine clinician preferences, format and content for a severe asthma resource.ParticipantsA reference group from stakeholder and consumer bodies and severe asthma experts provided advice and feedback. A multidisciplinary team of international experts was engaged to develop content. Written content was based on up-to-date literature. Peer and editorial review were performed to finalise content and inform web design. Website design focused on user experience, navigation, engagement, interactivity and tailoring of content for a clinical audience.ResultsA web-based resource was developed. Roundtable discussions and a needs assessment survey identified the need for dedicated severe asthma management resources to support skills training. The end-product, which launched 26 March 2018, includes an overview of severe asthma, diagnosis and assessment, management, medications, comorbidities, living with severe asthma, establishing a clinic, paediatrics/adolescents and clinical resources. Analytics indicate access by users worldwide (32 169 users from 169 countries). User survey results (n=394) confirm access by the target audience (72% health professionals), who agreed the toolkit increased their knowledge (73%) and confidence in managing severe asthma (66%), and 75% are likely to use the resource in clinic.ConclusionsThe Severe Asthma Toolkit is a unique, evidence-based internet resource to support healthcare professionals providing optimal care for people with severe asthma. It is a comprehensive, accessible and independent resource developed by leading severe asthma experts to improve clinician knowledge and skills in severe asthma management.

Effectiveness of an intervention to improve antibiotic-prescribing behaviour in primary care: a controlled, interrupted time-series study

2019 ◽  
Vol 74 (9) ◽  
pp. 2788-2796 ◽  
Author(s):  
António Teixeira Rodrigues ◽  
Fátima Roque ◽  
Maria Piñeiro-Lamas ◽  
Amílcar Falcão ◽  
Adolfo Figueiras ◽  
...  
Keyword(s):  
Primary Care ◽  
Time Series ◽  
Quality Indicators ◽  
Health Professionals ◽  
Controlled Trial ◽  
Interrupted Time Series ◽  
Fourth Generation ◽  
Antibiotic Prescribing ◽  
Health Administration ◽  
Narrow Spectrum

Abstract Background High rates of antibiotic misprescribing in primary care, with alarming clinical and economic consequences, highlight the urgent need for interventions to improve antibiotic prescribing in this setting. Objectives To assess the effectiveness on antibiotic prescribing quality indicators of a multifaceted intervention targeting health professionals’ and patients’ behaviour regarding antibiotic use. Methods We conducted a pragmatic cluster-randomized controlled trial in the catchment area covered by Portugal’s Central Regional Health Administration. The intervention consisted of a multidisciplinary, multifaceted programme involving physicians, pharmacists and patients, and comprising outreach visits for physicians and pharmacists, and educational materials for health professionals and patients. The following were assessed: relative ratios of prescription of penicillins sensitive to β-lactamase, penicillin combinations including β-lactamase inhibitors, third- and fourth-generation cephalosporins and fluoroquinolones; and the ratio of broad- to narrow-spectrum antibiotics. An interrupted time-series analysis for multiple-group comparisons was performed. The study protocol was registered on Clinical.trials.gov (NCT02173509). Results The participation rate in the educational intervention was 64% (197/309 GPs) in a total of 25 counties. Statistically significant improvements were obtained, not only in the relative prescription of penicillins sensitive to β-lactamase (overall relative change of +896%) and penicillin combinations including β-lactamase inhibitors (−161%), but also in the ratio of broad- to narrow-spectrum antibiotics (−200%). Statistically significant results were also obtained for third- and fourth-generation cephalosporins, though only in the immediate term. Conclusions This study showed that quality indicators of antibiotic prescribing can be improved by tackling influences on behaviour including knowledge and attitudes surrounding physicians’ clinical practice. Accordingly, these determinants must be considered when implementing interventions aimed at improving antibiotic prescribing.

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