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

doi:10.1186/s12875-021-01371-6

. 2021 Jan 23;22(1):25.

doi: 10.1186/s12875-021-01371-6.

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

Aleksandra J Borek^#¹, Anne Campbell^#², Elle Dent³, Christopher C Butler³, Alison Holmes², Michael Moore⁴, A Sarah Walker^{5

6

7}, Monsey McLeod^#^{2

8

9}, Sarah Tonkin-Crine^#^{3

5}; STEP-UP study team

Collaborators, Affiliations

Collaborators

Affiliations

¹ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK. Aleksandra.borek@phc.ox.ac.uk.
² National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK.
³ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
⁴ Primary Care Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK.
⁵ NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK.
⁶ NIHR Oxford Biomedical Research Centre, Oxford, UK.
⁷ Nuffield Department of Medicine, University of Oxford, Oxford, UK.
⁸ Centre for Medication Safety and Service Quality, Pharmacy Department, Imperial College Healthcare NHS Trust, London, UK.
⁹ NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK.

^# Contributed equally.

PMID: 33485324
PMCID: PMC7825381
DOI: 10.1186/s12875-021-01371-6

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

Aleksandra J Borek et al. BMC Fam Pract. 2021.

. 2021 Jan 23;22(1):25.

doi: 10.1186/s12875-021-01371-6.

Authors

Collaborators

Affiliations

¹ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK. Aleksandra.borek@phc.ox.ac.uk.
² National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK.
³ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
⁴ Primary Care Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK.
⁵ NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK.
⁶ NIHR Oxford Biomedical Research Centre, Oxford, UK.
⁷ Nuffield Department of Medicine, University of Oxford, Oxford, UK.
⁸ Centre for Medication Safety and Service Quality, Pharmacy Department, Imperial College Healthcare NHS Trust, London, UK.
⁹ NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK.

^# Contributed equally.

PMID: 33485324
PMCID: PMC7825381
DOI: 10.1186/s12875-021-01371-6

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.

Keywords: Antibiotic resistance; Antibiotics; Antimicrobial stewardship; Back-up prescription; Focus groups; General practice; Point-of-care testing.

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Conflict of interest statement

The authors declare that they have no competing interests.

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References

1. Public Health England. English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) Report 2018–2019. [Internet]. London: Public Health England; 2019. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploa...
1. Palin V, Mölter A, Belmonte M, Ashcroft DM, White A, Welfare W, et al. Antibiotic prescribing for common infections in UK general practice: variability and drivers. J Antimicrob Chemother. 2019;74(8):2440–2450. doi: 10.1093/jac/dkz163. - DOI - PMC - PubMed
1. Dolk FCK, Pouwels KB, Smith DRM, Robotham JV, Smieszek T. Antibiotics in primary care in England: which antibiotics are prescribed and for which conditions? J Antimicrob Chemother. 2018;73(suppl_2):ii2–i10. doi: 10.1093/jac/dkx504. - DOI - PMC - PubMed
1. Curtis HJ, Walker AJ, Mahtani KR, Goldacre B. Time trends and geographical variation in prescribing of antibiotics in England 1998–2017. J Antimicrob Chemother. 2019;74(1):242–250. - PubMed
1. Hope EC, Crump RE, Hollingsworth TD, Smieszek T, Robotham JV, Pouwels KB. Identifying English practices that are high antibiotic prescribers accounting for comorbidities and other legitimate medical reasons for variation. EClinicalMedicine. 2018;6:36–41. doi: 10.1016/j.eclinm.2018.12.003. - DOI - PMC - PubMed

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[1] Public Health England. English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) Report 2018–2019. [Internet]. London: Public Health England; 2019. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploa...

[2] Public Health England. English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) Report 2018–2019. [Internet]. London: Public Health England; 2019. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploa...

[3] Palin V, Mölter A, Belmonte M, Ashcroft DM, White A, Welfare W, et al. Antibiotic prescribing for common infections in UK general practice: variability and drivers. J Antimicrob Chemother. 2019;74(8):2440–2450. doi: 10.1093/jac/dkz163. - DOI - PMC - PubMed

[4] Palin V, Mölter A, Belmonte M, Ashcroft DM, White A, Welfare W, et al. Antibiotic prescribing for common infections in UK general practice: variability and drivers. J Antimicrob Chemother. 2019;74(8):2440–2450. doi: 10.1093/jac/dkz163. - DOI - PMC - PubMed

[5] Dolk FCK, Pouwels KB, Smith DRM, Robotham JV, Smieszek T. Antibiotics in primary care in England: which antibiotics are prescribed and for which conditions? J Antimicrob Chemother. 2018;73(suppl_2):ii2–i10. doi: 10.1093/jac/dkx504. - DOI - PMC - PubMed

[6] Dolk FCK, Pouwels KB, Smith DRM, Robotham JV, Smieszek T. Antibiotics in primary care in England: which antibiotics are prescribed and for which conditions? J Antimicrob Chemother. 2018;73(suppl_2):ii2–i10. doi: 10.1093/jac/dkx504. - DOI - PMC - PubMed

[7] Curtis HJ, Walker AJ, Mahtani KR, Goldacre B. Time trends and geographical variation in prescribing of antibiotics in England 1998–2017. J Antimicrob Chemother. 2019;74(1):242–250. - PubMed

[8] Curtis HJ, Walker AJ, Mahtani KR, Goldacre B. Time trends and geographical variation in prescribing of antibiotics in England 1998–2017. J Antimicrob Chemother. 2019;74(1):242–250. - PubMed

[9] Hope EC, Crump RE, Hollingsworth TD, Smieszek T, Robotham JV, Pouwels KB. Identifying English practices that are high antibiotic prescribers accounting for comorbidities and other legitimate medical reasons for variation. EClinicalMedicine. 2018;6:36–41. doi: 10.1016/j.eclinm.2018.12.003. - DOI - PMC - PubMed

[10] Hope EC, Crump RE, Hollingsworth TD, Smieszek T, Robotham JV, Pouwels KB. Identifying English practices that are high antibiotic prescribers accounting for comorbidities and other legitimate medical reasons for variation. EClinicalMedicine. 2018;6:36–41. doi: 10.1016/j.eclinm.2018.12.003. - DOI - PMC - PubMed

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

Collaborators

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

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

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