scholarly journals Antibiotic Prescribing Trends in Belgian Out-of-Hours Primary Care during the COVID-19 Pandemic: Observational Study Using Routinely Collected Health Data

Antibiotics ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 1488
Author(s):  
Annelies Colliers ◽  
Jeroen De Man ◽  
Niels Adriaenssens ◽  
Veronique Verhoeven ◽  
Sibyl Anthierens ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Health Data ◽  
Antibiotic Prescribing ◽  
Out Of Hours ◽  
Face To Face ◽  
Percentage Points ◽  
Routinely Collected Health Data ◽  
Tract Infections ◽  
The Impact

Antibiotic overprescribing is one of the main drivers of the global and growing problem of antibiotic resistance, especially in primary care and for respiratory tract infections (RTIs). RTIs are the most common reason for patients to consult out-of-hours (OOH) primary care. The COVID-19 pandemic has changed the way general practitioners (GPs) work, both during office hours and OOH. In Belgian OOH primary care, remote consultations with the possibility of issuing prescriptions and telephone triage were implemented. We aimed to describe the impact of COVID-19 on GPs’ antibiotic prescribing during OOH primary care. In an observational study, using routinely collected health data from GP cooperatives (GPCs) in Flanders, we analyzed GPs’ antibiotic prescriptions in 2019 (10 GPCs) and 2020 (20 GPCs) during OOH consultations (telephone and face-to-face). We used autoregressive integrated moving average (ARIMA) modeling to identify any changes after lockdowns were implemented. In total, 388,293 contacts and 268,430 prescriptions were analyzed in detail. The number of antibiotic prescriptions per weekend, per 100,000 population was 11.47 (95% CI: 9.08–13.87) or 42.9% lower after compared to before the implementation of lockdown among all contacts. For antibiotic prescribing per contact, we found a decrease of 12.2 percentage points (95% CI: 10.6–13.7) or 56.5% among all contacts and of 5.3 percentage points (95% CI: 3.7–6.9) or 23.2% for face-to-face contacts only. The decrease in the number of prescriptions was more pronounced for cases with respiratory symptoms that corresponded with symptoms of COVID-19 and for antibiotics that are frequently prescribed for RTIs, such as amoxicillin (a decrease of 64.9%) and amoxicillin/clavulanate (a decrease of 38.1%) but did not appear for others such as nitrofurantoin. The implementation of COVID-19 lockdown measures coincided with an unprecedented drop in the number of antibiotic prescriptions, which can be explained by a decrease in face-to-face patient contacts, as well as a lower number of antibiotics prescriptions per face-to-face patient contact. The decrease was seen for antibiotics used for RTIs but not for nitrofurantoin, the first-choice antibiotic for urinary tract infections.

Local implementation of AMS initiatives: a mixed-methods study

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697025 ◽  
Author(s):  
Rosalie Allison ◽  
Donna Lecky ◽  
Elizabeth Beech ◽  
Ceire Costelloe ◽  
Diane Ashiru-Oredope ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Interviews ◽  
Antibiotic Prescribing ◽  
Out Of Hours ◽  
Face To Face ◽  
E Learning ◽  
General Practices ◽  
Primary Care Practitioners ◽  
Future Work ◽  
Common Infections

BackgroundThe NHS English Quality Premium recommends that inappropriate antibiotic prescribing is reduced; there are a range of national antimicrobial stewardship (AMS) initiatives to support this.AimThe aim of this study is to assess AMS activities in primary care across England. The findings will be used to inform how the RCGP, PHE and NHS can help optimise stewardship activities.MethodQualitative interviews: with AMS leads within Clinical Commissioning Groups’ (CCGs) and Commissioning Support Units’ (CSUs) medicines management teams. Questionnaire: informed by the qualitative data, sent to all 209 CCGs in England in 2017.ResultsIn total, 89% (187/209) of CCGs returned a questionnaire; 82% of AMS leads reported spending only 0.1 whole-time equivalent on AMS activities, as it was only one role within a wider remit, so dedicating time is challenging. 99% (167/169) of CCGs had delivered AMS education in the last 2 years: 140 face-to-face; 121 via e-learning. 99% (184/186) actively promoted the TARGET Antibiotics Toolkit; 94% (175/187) actively promoted TARGET patient leaflets: 92% The Treating Your Infection (TYI) leaflet. 90% (166/185) used the PHE managing common infections guidance: 81% (149/185) modify or localise; 41/185 (22%) signpost directly to it. Eighty-six CCGs reported using CCG audit tools and 82 CCGs reported using TARGET’s audit tools. 85% (142/168) fed back antimicrobial prescribing data to the CCG/CSU board; 100% (169/169) to general practices and 33% (56/169) to out-of-hours providers.ConclusionAlthough CCGs reported promoting these AMS activities, there was little evaluation of uptake by primary care practitioners. Future work should focus on measuring AMS uptake; having staff dedicated solely to AMS could facilitate this.

scholarly journals Antibiotic Prescribing and Doctor-Patient Communication During Consultations for Respiratory Tract Infections: A Video Observation Study in Out-of-Hours Primary Care

2021 ◽  
Vol 8 ◽  
Author(s):  
Annelies Colliers ◽  
Katrien Bombeke ◽  
Hilde Philips ◽  
Roy Remmen ◽  
Samuel Coenen ◽  
...  
Keyword(s):  
Primary Care ◽  
Respiratory Tract ◽  
General Practitioners ◽  
Communication Skills ◽  
Respiratory Tract Infections ◽  
Patient Expectations ◽  
Antibiotic Prescribing ◽  
Out Of Hours ◽  
Doctor Patient Communication ◽  
Tract Infections

Objective: Communication skills can reduce inappropriate antibiotic prescribing, which could help to tackle antibiotic resistance. General practitioners often overestimate patient expectations for an antibiotic. In this study, we describe how general practitioners and patients with respiratory tract infections (RTI) communicate about their problem, including the reason for encounter and ideas, concerns, and expectations (ICE), and how this relates to (non-)antibiotic prescribing in out-of-hours (OOH) primary care.Methods: A qualitative descriptive framework analysis of video-recorded consultations during OOH primary care focusing on doctor-patient communication.Results: We analyzed 77 videos from 19 general practitioners. General practitioners using patient-centered communication skills received more information on the perspective of the patients on the illness period. For some patients, the reason for the encounter was motivated by their belief that a general practitioner (GP) visit will alter the course of their illness. The ideas, concerns, and expectations often remained implicit, but the concerns were expressed by the choice of words, tone of voice, repetition of words, etc. Delayed prescribing was sometimes used to respond to implicit patient expectations for an antibiotic. Patients accepted a non-antibiotic management plan well.Conclusion: Not addressing the ICE of patients, or their reason to consult the GP OOH, could drive assumptions about patient expectations for antibiotics early on and antibiotic prescribing later in the consultation.

scholarly journals Antibiotic prescribing for acute infections in synchronous telehealth consultations: a systematic review and meta-analysis

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0106
Author(s):  
Mina Bakhit ◽  
Emma Baillie ◽  
Natalia Krzyzaniak ◽  
Mieke van Driel ◽  
Justin Clark ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Acute Infection ◽  
Acute Otitis Media ◽  
Relative Increase ◽  
Antibiotic Prescribing ◽  
Tract Infections ◽  
The Impact

BackgroundAntibiotic prescribing is a major concern that contributes to the problem of antibiotic resistance.AimTo assess the effect on antibiotic prescribing in primary care of telehealth (TH) consultations compared to face-to-face (F2F).Design & settingSystematic review and meta-analysis of adult or paediatric patients with a history of a community acquired acute infection (respiratory, urinary, or skin and soft tissue). We included studies that compared synchronous TH consultations (phone or video based) to F2F consultations in primary care.MethodWe searched PubMed, Embase, Cochrane CENTRAL (inception-2021), clinical trial registries and citing-cited references of included studies. Two review authors independently screened the studies and extracted the data.ResultsWe identified 13 studies. The one small randomised controlled trial found a non-significant 25% relative increase in antibiotic prescribing in the TH group. The remaining 10 were observational studies but did not control well for confounding, and therefore at high risk of bias. When pooled by specific infections, there was no consistent pattern. The six studies of sinusitis – including one before-after study - showed significantly less prescribing for acute rhinosinusitis in TH consultations, whereas the two studies of acute otitis media showed a significant increase. Pharyngitis, conjunctivitis, and urinary tract infections showed not-significant higher prescribing in the TH group. Bronchitis showed no change.ConclusionsThe impact of telehealth on prescribing appears to vary between conditions with more increases than reductions. However, there is insufficient evidence to draw strong conclusions, and higher quality research is urgently needed.

scholarly journals Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review

10.2196/23482 ◽  
2020 ◽  
Vol 22 (11) ◽  
pp. e23482 ◽  
Author(s):  
Seung Min Han ◽  
Geva Greenfield ◽  
Azeem Majeed ◽  
Benedict Hayhoe
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Antibiotic Prescribing ◽  
Remote Consultation ◽  
Face To Face ◽  
Primary Health ◽  
The Impact ◽  
Remote Consultations

Background There has been growing international interest in performing remote consultations in primary care, particularly amidst the current COVID-19 pandemic. Despite this, the evidence surrounding the safety of remote consultations is inconclusive. The appropriateness of antibiotic prescribing in remote consultations is an important aspect of patient safety that needs to be addressed. Objective This study aimed to summarize evidence on the impact of remote consultation in primary care with regard to antibiotic prescribing. Methods Searches were conducted in MEDLINE, Embase, HMIC, PsycINFO, and CINAHL for literature published since the databases’ inception to February 2020. Peer-reviewed studies conducted in primary health care settings were included. All remote consultation types were considered, and studies were required to report any quantitative measure of antibiotic prescribing to be included in this systematic review. Studies were excluded if there were no comparison groups (face-to-face consultations). Results In total, 12 studies were identified. Of these, 4 studies reported higher antibiotic-prescribing rates, 5 studies reported lower antibiotic-prescribing rates, and 3 studies reported similar antibiotic-prescribing rates in remote consultations compared with face-to-face consultations. Guideline-concordant prescribing was not significantly different between remote and face-to-face consultations for patients with sinusitis, but conflicting results were found for patients with acute respiratory infections. Mixed evidence was found for follow-up visit rates after remote and face-to-face consultations. Conclusions There is insufficient evidence to confidently conclude that remote consulting has a significant impact on antibiotic prescribing in primary care. However, studies indicating higher prescribing rates in remote consultations than in face-to-face consultations are a concern. Further, well-conducted studies are needed to inform safe and appropriate implementation of remote consulting to ensure that there is no unintended impact on antimicrobial resistance.

scholarly journals Reducing inappropriate outpatient antibiotic prescribing: normative comparison using unblinded provider reports

2019 ◽  
Vol 8 (1) ◽  
pp. e000351 ◽  
Author(s):  
Richard V Milani ◽  
Jonathan K Wilt ◽  
Jonathan Entwisle ◽  
Jonathan Hand ◽  
Pedro Cazabon ◽  
...  
Keyword(s):  
Primary Care ◽  
Patient Education ◽  
Test Group ◽  
Primary Care Providers ◽  
Antibiotic Prescribing ◽  
Care Providers ◽  
Normative Comparison ◽  
Second Year ◽  
Tract Infections ◽  
The Impact

ImportanceAntibiotic resistance is a global health issue. Up to 50% of antibiotics are inappropriately prescribed, the majority of which are for acute respiratory tract infections (ARTI).ObjectiveTo evaluate the impact of unblinded normative comparison on rates of inappropriate antibiotic prescribing for ARTI.DesignNon-randomised, controlled interventional trial over 1 year followed by an open intervention in the second year.SettingPrimary care providers in a large regional healthcare system.ParticipantsThe test group consisted of 30 primary care providers in one geographical region; controls consisted of 162 primary care providers located in four other geographical regions.InterventionThe intervention consisted of provider and patient education and provider feedback via biweekly, unblinded normative comparison highlighting inappropriate antibiotic prescribing for ARTI. The intervention was applied to both groups during the second year.Main outcomes and measuresRate of inappropriate antibiotic prescription for ARTI.ResultsBaseline inappropriate antibiotic prescribing for ARTI was 60%. After 1 year, the test group rate of inappropriate antibiotic prescribing decreased 40%, from 51.9% to 31.0% (p<0.0001), whereas controls decreased 7% (61.3% to 57.0%, p<0.0001). In year 2, the test group decreased an additional 47% to an overall prescribing rate of 16.3%, and the control group decreased 40% to a prescribing rate of 34.5% after implementation of the same intervention.Conclusions and relevanceProvider and patient education followed by regular feedback to provider via normative comparison to their local peers through unblinded provider reports, lead to reductions in the rate of inappropriate antibiotic prescribing for ARTI and overall antibiotic prescribing rates.

scholarly journals 162. The Impact of the COVID-19 Pandemic on Antibiotic Prescribing in Pediatric Primary Care

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S97-S98
Author(s):  
Lauren Dutcher ◽  
Yun Li ◽  
Giyoung Lee ◽  
Robert Grundmeier ◽  
Keith W Hamilton ◽  
...  
Keyword(s):  
Primary Care ◽  
Urinary Tract ◽  
Soft Tissue ◽  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Interrupted Time Series ◽  
Pediatric Primary Care ◽  
Antibiotic Prescribing ◽  
Tract Infections ◽  
The Impact

Abstract Background With the onset of the coronavirus disease 2019 (COVID-19) pandemic, pediatric primary care delivery changed rapidly. Prior studies have demonstrated a reduction in ambulatory encounters and antibiotic prescriptions with the pandemic onset; however, the durability of these reductions in pediatric primary care in the United States has not been assessed. Methods We conducted a retrospective cohort study to assess the impact of the COVID-19 pandemic and associated public health measures (e.g. social distancing, masking, school closures, and increased availability of telemedicine) on antibiotic prescribing and encounter volume in 27 pediatric primary care practices, and the duration of these changes. Patients under age 19 with an encounter from January 1, 2018 through December 31, 2020 were included. The primary outcome was monthly antibiotic prescriptions per 1000 patients, in the overall population and a subset of encounters with infectious diagnoses, including respiratory tract infections (RTIs). Interrupted time series (ITS) analysis was performed. Results There were 60,562 total antibiotic prescriptions from April to December in 2019 and 14,605 antibiotic prescriptions during the same months in 2020, a 76% reduction. The reduction in RTI encounter prescriptions accounted for 91.5% of the overall reduction in prescriptions from 2019 to 2020. Using ITS analysis, there was an immediate decrease from 31.6 to 7.4 prescriptions/1000 patients (predicted means) in April 2020 (-24.2 prescriptions/1000 patients; 95% CI: -31.9, -16.4) (Figures 1 and 2). This was followed by a stable rate of antibiotic prescriptions that remained flat through December 2020. For RTI encounters, a similar pattern was seen, with a decrease by 21.8 prescriptions/1000 patients; 95% CI: -29.5, -14.2) (Figures 1 and 2). Encounter volume also decreased immediately, and while overall encounter volume began returning to a pre-pandemic baseline volume toward the end of the study period, RTI encounter volume remained persistently lower through December 2020 (Figure 3). Figure 1. Antibiotic prescriptions per 1000 patients prescribed by month from January 2018 to December 2020, overall and for disease-specific subgroups RTI = respiratory tract infection; UTI = urinary tract infection; SSTI = skin and soft tissue infection. Months are numbered sequentially, starting with January (number 1). Dashed line indicates first full month of the pandemic, April 2020. Interrupted time series analysis for antibiotic prescriptions per 1000 patients by month from January 2018 to December 2020 for (A) all antibiotics as well as antibiotics prescribed at encounters with (B) respiratory tract infections (RTIs), (C) urinary tract infections (UTIs), and (D) skin and soft tissue infections (SSTIs) Intervention starts in April 2020 (dashed line). Months are numbered sequentially, starting with January (number 1). Dashed line indicates first full month of the pandemic, April 2020. Antibiotic prescriptions per 1000 billed encounters by month from January 2018 to December 2020 for (A) all encounters, as well as antibiotics prescribed at encounters with (B) respiratory tract infections (RTIs), (C) urinary tract infections (UTIs), and (D) skin and soft tissue infections (SSTIs) Months are numbered sequentially, starting with January (number 1). Conclusion Dramatic reductions in antibiotic prescribing in pediatric primary care during the COVID-19 pandemic were sustained through 2020, primarily driven by reductions in RTI encounters. Disclosures All Authors: No reported disclosures

scholarly journals Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (Preprint)

2020 ◽  
Author(s):  
Seung Min Han ◽  
Geva Greenfield ◽  
Azeem Majeed ◽  
Benedict Hayhoe
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Antibiotic Prescribing ◽  
Remote Consultation ◽  
Face To Face ◽  
Primary Health ◽  
The Impact ◽  
Remote Consultations

BACKGROUND There has been growing international interest in performing remote consultations in primary care, particularly amidst the current COVID-19 pandemic. Despite this, the evidence surrounding the safety of remote consultations is inconclusive. The appropriateness of antibiotic prescribing in remote consultations is an important aspect of patient safety that needs to be addressed. OBJECTIVE This study aimed to summarize evidence on the impact of remote consultation in primary care with regard to antibiotic prescribing. METHODS Searches were conducted in MEDLINE, Embase, HMIC, PsycINFO, and CINAHL for literature published since the databases’ inception to February 2020. Peer-reviewed studies conducted in primary health care settings were included. All remote consultation types were considered, and studies were required to report any quantitative measure of antibiotic prescribing to be included in this systematic review. Studies were excluded if there were no comparison groups (face-to-face consultations). RESULTS In total, 12 studies were identified. Of these, 4 studies reported higher antibiotic-prescribing rates, 5 studies reported lower antibiotic-prescribing rates, and 3 studies reported similar antibiotic-prescribing rates in remote consultations compared with face-to-face consultations. Guideline-concordant prescribing was not significantly different between remote and face-to-face consultations for patients with sinusitis, but conflicting results were found for patients with acute respiratory infections. Mixed evidence was found for follow-up visit rates after remote and face-to-face consultations. CONCLUSIONS There is insufficient evidence to confidently conclude that remote consulting has a significant impact on antibiotic prescribing in primary care. However, studies indicating higher prescribing rates in remote consultations than in face-to-face consultations are a concern. Further, well-conducted studies are needed to inform safe and appropriate implementation of remote consulting to ensure that there is no unintended impact on antimicrobial resistance.

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