scholarly journals Improving Our Understanding and Practice of Antibiotic Prescribing: A Study on the Use of Social Norms Feedback Letters in Primary Care

2021 ◽  
Vol 18 (5) ◽  
pp. 2602
Author(s):  
Stephanie Steels ◽  
Natalie Gold ◽  
Victoria Palin ◽  
Tim Chadborn ◽  
Tjeerd Pieter van Staa
Keyword(s):  
Primary Care ◽  
Social Norms ◽  
Medical Officer ◽  
Participatory Approach ◽  
Antibiotic Prescribing ◽  
Behavioural Science ◽  
Face To Face ◽  
Engagement Strategies ◽  
Prescribing Behaviour ◽  
The Uk

In the UK, 81% of all antibiotics are prescribed in primary care. Previous research has shown that a letter from the Chief Medical Officer (CMO) giving social norms feedback to General Practitioners (GPs) whose practices are high prescribers of antibiotics can decrease antibiotic prescribing. The aim of this study was to understand the best way for engaging with GPs to deliver feedback on prescribing behaviour that could be replicated at scale; and explore GP information requirements that would be needed to support prescribing behaviour change. Two workshops were devised utilising a participatory approach. Discussion points were noted and agreed with each group of participants. Minutes of the workshops and observation notes were taken. Data were analysed thematically. Four key themes emerged through the data analysis: (1) Our day-to-day reality, (2) GPs are competitive, (3) Face-to-face support, and (4) Empowerment and engagement. Our findings suggest there is potential for using behavioural science in the form of social norms as part of a range of engagement strategies in reducing antibiotic prescribing within primary care. This should include tailored and localised data with peer-to-peer comparisons.

scholarly journals A qualitative exploration of patients’ experiences, needs and expectations regarding online access to their primary care record

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044221
Author(s):  
Brian McMillan ◽  
Gail Davidge ◽  
Lindsey Brown ◽  
Moira Lyons ◽  
Helen Atherton ◽  
...  
Keyword(s):  
Primary Care ◽  
Focus Groups ◽  
Negative Consequences ◽  
Face To Face ◽  
Primary Care Record ◽  
Online Access ◽  
Additional Support ◽  
The Uk ◽  
Records Access ◽  
Qualitative Exploration

ObjectivesPrimary care records have traditionally served the needs and demands of clinicians rather than those of the patient. In England, general practices must promote and offer registered patients online access to their primary care record, and research has shown benefits to both patients and clinicians of doing so. Despite this, we know little about patients’ needs and expectations regarding online access to their record. This study explored what patients and carers want from online access to their electronic primary care health record, their experiences of using it, how they would like to interact with their record and what support they may need.DesignFocus groups and semistructured interviews using purposive sampling to achieve a good sociodemographic spread. Interviews were digitally audiorecorded, transcribed and coded using an established thematic approach.SettingFocus groups and interviews were conducted in community settings in the UK.ParticipantsFifty-four individuals who were either eligible for the National Health Service Health Check, living with more than one long-term condition or caring for someone else.ResultsParticipants views regarding online access were categorised into four main themes: awareness, capabilities, consequences and inevitability. Participants felt online access should be better promoted, and suggested a number of additional functions, such as better integration with other parts of the healthcare system. It was felt that online access could improve quality of care (eg, through increased transparency) but also have potential negative consequences (eg, by replacing face to face contact). A move towards more online records access was considered inevitable, but participants noted a need for additional support and training in using the online record, especially to ensure that health inequalities are not exacerbated.ConclusionsDiscussions with patients and carers about their views of accessing online records have provided useful insights into future directions and potential improvements for this service.

scholarly journals COVID-19 Pandemic: The Urgent Dental Hub experience from a primary care perspective

2021 ◽  
Vol 10 (3) ◽  
pp. 41-45
Author(s):  
Zohaib Khwaja ◽  
Awais Ali ◽  
Manraj Rai
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Dental Care ◽  
Specialist Care ◽  
Health Message ◽  
Face To Face ◽  
General Dental Practitioner ◽  
Public Health Message ◽  
The Uk

In response to the nationwide lockdown on 23 March 2020 in the UK, urgent dental hubs (UDHs) were established in the community to provide emergency dental care. Consecutive referrals to a primary care UDH were prospectively analysed over a one-month period, from 18 May 2020 to 18 June 2020. Of 400 referrals received, the most common were in relation to pain (87%). In 63% neither a radiograph nor photograph was provided with the referral. Seventy percent of patients were telephone triaged within 24 hours of receipt of referral. Fifty-three percent of referrals were accepted for face-to-face treatment, of which 69% were treated by extraction. Of rejected referrals (n=179; 45%), 79% were due to symptoms having settled or being manageable by the time of triage. A small number of referrals were redirected for specialist care. Referrals that were accepted were more likely to have been prescribed antibiotics and less likely to have been referred by the general dental practitioner (GDP) they regularly saw (p <0.01). Patients that were older and those that identified themselves as not having a regular GDP were less likely to have been referred to an UDH. The quality of referrals was poor and there may be a role for virtual consultations moving forwards. We found pre-referral antimicrobial prescriptions were high and a confused public health message may have been sent.

A qualitative literature review exploring the drivers influencing antibiotic over-prescribing by GPs in primary care and recommendations to reduce unnecessary prescribing

2019 ◽  
Vol 141 (1) ◽  
pp. 19-27 ◽  
Author(s):  
Joanna Rose ◽  
Michelle Crosbie ◽  
Antony Stewart
Keyword(s):  
Primary Care ◽  
Antibiotic Resistance ◽  
Literature Review ◽  
External Factors ◽  
Working Environment ◽  
Antibiotic Prescribing ◽  
Main Theme ◽  
Prescribing Behaviour ◽  
The Impact ◽  
Qualitative Literature

Aims: This qualitative literature review aims to critically assess and analyse published literature to determine drivers influencing over-prescribing by general practitioners (GPs) in primary care, exploring their views and opinions, and also to determine how antibiotic prescribing can be improved and unnecessary prescribing reduced, thus reducing the threat to public health from antibiotic resistance. It is intended to develop new thinking in this area and add to existing knowledge concerning GPs’ antibiotic prescribing behaviour. Methods: Thematic analysis following Braun and Clarke’s 2006 framework was used to analyse 17 qualitative studies chosen from EBSCOhost databases, focusing on GPs’ views of antibiotic prescribing in primary care, with specific search strategies and inclusion criteria to ensure study quality and trustworthiness. Results: Three main themes and nine sub-themes were generated from the studies. The first main theme discussed GP factors related to over-prescribing, the main drivers being GP attitudes and feelings and anxiety/fear concerning prescribing. The second theme highlighted external factors, with pressures from time and financial issues as the main drivers within this theme. The final theme marked patient pressure, demand and expectation with lack of patient education as the major drivers affecting GP over-prescribing. Conclusion: The findings of this research show GPs’ antibiotic prescribing in primary care is complex, being influenced by many internal and external factors. A multifaceted approach to interventions targeting the drivers identified could significantly reduce the level of antibiotic prescribing thus minimising the impact of antibiotic resistance and promoting a more efficient working environment for GPs and patients alike.

View from the top: a thematic analysis of interviews with top healthcare leaders in the UK about leadership and how UK GPs should prepare for it

BMJ Leader ◽  
2018 ◽  
Vol 2 (4) ◽  
pp. 136-139
Author(s):  
Veronica Wilkie ◽  
Kay Mohanna
Keyword(s):  
Primary Care ◽  
Leadership Training ◽  
Work Force ◽  
Senior Leaders ◽  
Face To Face ◽  
New Information ◽  
Personal Qualities ◽  
The Uk ◽  
Medical Leadership ◽  
Future Work

IntroductionLeadership is often quoted as being a solution to future work force problems . This study looks at the views of leaders within the NHS to find out what they think should be done, how and when for GPs in training.MethodsA series of interviews were carried out with senior leaders within the NHS, within primary care, NHS England and Health Education England. All the participants were involved in primary care either assenior general practitioners, senior educators, or clinical and non clinical managers. The interviews were face to face or via a telephone and recorded before being transcribed and analysed. The interviews were carried out until no new information was forthcoming.ResultsAll of the participants agreed that leadership was necessary. Non clinicians tended to think that the training was best done once a GP had arrived at a senior leadership position, clinicians tended to think leadership training should happen from the start of the career. The competences identified fitted within those originally identified from the Medical Leadership Competency Framework.DiscussionLeadership training is still regarded as important and overall the senior leaders recognised the need for personal qualities, the ability to lead and work in teams, how to manage and improve services and how to set direction for change. The difficulties of organizing this and how to fit this in with the needs of service delivery and current curriculum was highlighted.

Student paramedics' views on placements in general practice as part of a degree

2019 ◽  
Vol 11 (12) ◽  
pp. 519-525
Author(s):  
Alyesha Proctor
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Care Pathway ◽  
Structured Interviews ◽  
Learning And Development ◽  
Alternative Care ◽  
Face To Face ◽  
The Uk ◽  
University Degree

Background: Frontline paramedics are increasingly attending to non-emergency problems and calls that could be managed by a primary care provider. Alongside this, there is a growing pressure to manage patients at home or use an alternative care pathway and reduce hospital conveyance. Student paramedic training, including both placement and taught elements at university, should therefore reflect this. However, placement opportunities for student paramedics in primary care settings is variable across the UK. Aim: To explore student paramedics' views on incorporating a placement within general practice as part of their degree and its effects on their learning and development as an autonomous paramedic. Method: A small pedagogic study as part of a postgraduate certificate in academic practice for higher education, involving a case study, qualitative approach using face-to-face, semi-structured interviews and thematic analysis, was carried out. Findings: Student paramedics feel that incorporating a placement in general practice as part of their degree will significantly help in their learning and development as autonomous paramedics. Specifically, they feel it: will help them understand the role of the GP and what the GP expects of them; will help them to focus their assessments and improve confidence in decisions not to convey patients; may lead to better knowledge of alternative care pathways; and, finally, may provide an insight into the role of the paramedic in general practice as a future career opportunity. There are a few reservations about whether students would be able to use the skills and knowledge gained in this setting, as they feel they do not have access to the tools or the authority in a frontline ambulance service. Students would prefer to have a placement in a GP surgery in the final year of their university degree. Conclusion: Placement within a GP surgery for student paramedics should be included as part of a paramedic science degree as a priority. This is necessary, particularly given the changing role of the contemporary paramedic who attends to non-emergency problems.

scholarly journals Why did some practices not implement new antibiotic prescribing guidelines on urinary tract infection? A cohort study and survey in NHS England primary care

2018 ◽  
Author(s):  
Richard Croker ◽  
Alex J Walker ◽  
Ben Goldacre
Keyword(s):  
Primary Care ◽  
Time Series ◽  
Interrupted Time Series ◽  
Freedom Of Information ◽  
Antibiotic Prescribing ◽  
Incentive Scheme ◽  
Line Treatment ◽  
First Line ◽  
Prescribing Behaviour ◽  
First Line Treatment

AbstractObjectivesTo describe prescribing trends and geographic variation for trimethoprim and nitrofurantoin; to describe variation in implementing guideline change; and to compare actions taken to reduce trimethoprim use in high- and low-using Clinical Commissioning Groups (CCGs).DesignA retrospective cohort study and interrupted time series analysis in English NHS primary care prescribing data; complemented by information obtained through Freedom of Information Act requests to CCGs. The main outcome measures were: variation in practice and CCG prescribing ratios geographically and over time, including an interrupted time-series; and responses to Freedom of Information requests.ResultsThe amount of trimethoprim prescribed, as a proportion of nitrofurantoin and trimethoprim combined, remained stable and high until 2014, then fell gradually to below 50% in 2017; this reduction was more rapid following the introduction of the Quality Premium. There was substantial variation in the speed of change between CCGs. As of April 2017, for the 10 worst CCGs (with the highest trimethoprim ratios): 9 still had trimethoprim as first line treatment for uncomplicated UTI (one CCG had no formulary); none had active work plans to facilitate change in prescribing behaviour away from trimethoprim; and none had implemented an incentive scheme for change in prescribing behaviour. For the 10 best CCGs: 2 still had trimethoprim as first line treatment (all CCGs had a formulary); 5 (out of 7 who answered this question) had active work plans to facilitate change in prescribing behaviour away from trimethoprim; and 5 (out of 10 responding) had implemented an incentive scheme for change in prescribing behaviour. 9 of the best 10 CCGs reported at least one of: formulary change, work plan, or incentive scheme. None of the worst 10 CCGs did so.ConclusionsMany CCGs failed to implement an important change in antibiotic prescribing guidance; and report strong evidence suggesting that CCGs with minimal prescribing change did little to implement the new guidance. We strongly recommend a national programme of training and accreditation for medicines optimisation pharmacists; and remedial action for CCGs that fail to implement guidance; with all materials and data shared publicly for both such activities.

scholarly journals EP.FRI.422 Over 100,000 COVID-19 deaths calls for a radical reform of health and care system in the UK

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Shruti Bodapati ◽  
Raghvinder Gambhir
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Secondary Care ◽  
Face To Face ◽  
Radical Reform ◽  
National Statistics ◽  
The Uk ◽  
Second Wave ◽  
Excess Deaths ◽  
Care System

Abstract Aim With over 100,000 deaths due to COVID 19 and still counting, is it a wake-up call to overhaul our health and care system. Methods Review of NHS England, Office of National Statistics (ONS) and Public Health England (PHE) data to determine where the deaths occurred and what role did the primary care, secondary care, play in delivering the service. Results The data shows that it took 40 weeks to get to the first 50,000 deaths and just another 10 weeks to add another 50,000 deaths. Among the OECD UK ranked number 1 for deaths due to COVID 19.  69.9%   of deaths occurred in hospitals, 24.1% in care homes, while 4.9% occurred at homes. The primary care effectively remained shut for face to face consultation, effectively leaving people to manage themselves at home on their own or reach A & E when things got worse. The hospitals where overwhelmed and coped by shutting out all elective work and converting normal wards to COVID wards and that is where the maximum deaths occurred. There were over 80000 excess deaths above the five-year average. Conclusion We may have been underprepared for the first wave but had the PPE and plans to battle the second wave yet we had the highest mortality in Europe. Is it a price we paid for our disjointed health and care system. There is a need for radical changes to prepare for future disasters.

scholarly journals Antibiotic prescribing in UK out-of-hours primary care services: a realist-informed scoping review of training and guidelines for health care professionals

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2020.0167
Author(s):  
Paula Gomes Alves ◽  
Gail Hayward ◽  
Geraldine Leydon ◽  
Rebecca Barnes ◽  
Catherine Woods ◽  
...  
Keyword(s):  
Primary Care ◽  
Scoping Review ◽  
Health Care Professionals ◽  
Clinical Guidelines ◽  
Grey Literature ◽  
Public Health Problem ◽  
Antibiotic Prescribing ◽  
Out Of Hours ◽  
Training Resources ◽  
The Uk

BackgroundAntibiotic overuse has contributed to antimicrobial resistance, a global public health problem. In the UK, despite the fall in rates of antibiotic prescription since 2013, prescribing levels remain high in comparison with other European countries. Prescribing in out of hours care (OOH) provides unique challenges for prudent prescribing, for which professionals may not be prepared.AimTo explore the guidance available to professionals on prescribing antibiotics for common infections in OOH primary care within the UK, with a focus on training resources, guidelines, and clinical recommendations.Design and methodWe carried out a realist-informed scoping review of peer-reviewed papers and grey literature focusing on antibiotic prescribing OOH (eg, clinical guidelines, training videos). General prescribing guidance was searched whenever OOH-focused resources were unavailable. Electronic databases and websites of national agencies and professional societies were searched following PRISMA standards. Findings were organised according to realist review components ie, mechanisms, contexts, and outcomes.Results46 clinical guidelines and eight training resources were identified. Clinical guidelines targeted adults and children and included recommendations on prescription strategy, spectrum of the antibiotic prescribed, communication with patients, treatment duration, and decision-making processes.ConclusionNo clinical guidelines or training resources focusing specifically on OOH were found. Our results highlight a lack of knowledge about whether existing resources address the challenges faced by OOH antibiotic prescribers. Further research is needed to explore the training needs of OOH health professionals, and whether further OOH-focused resources need to be developed given the rates of antibiotic prescribing in this setting.

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.

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