Best practice guidance for antibiotic audit and feedback interventions in primary care: a modified Delphi study from the Joint Programming Initiative on Antimicrobial resistance: Primary Care Antibiotic Audit and Feedback Network (JPIAMR-PAAN)

doi:10.1186/s13756-023-01279-z

. 2023 Jul 29;12(1):72.

doi: 10.1186/s13756-023-01279-z.

Best practice guidance for antibiotic audit and feedback interventions in primary care: a modified Delphi study from the Joint Programming Initiative on Antimicrobial resistance: Primary Care Antibiotic Audit and Feedback Network (JPIAMR-PAAN)

Kevin L Schwartz^{1

2

3}, Alice X T Xu^{4

5}, Sarah Alderson^{6

7}, Lars Bjerrum⁸, Jamie Brehaut⁹, Benjamin C Brown¹⁰, Heiner C Bucher¹¹, An De Sutter¹², Nick Francis¹³, Jeremy Grimshaw¹⁴, Ronny Gunnarsson^{15

16

17}, Sigurd Hoye¹⁸, Noah Ivers¹⁹, Donna M Lecky²⁰, Morten Lindbæk¹⁸, Jeffrey A Linder²¹, Paul Little²², Benedikte Olsen Michalsen¹⁸, Denise O'Connor²³, Celine Pulcini^{24

25}, Pär-Daniel Sundvall^{15

16

17}, Pia Touboul Lundgren²⁶, Jan Y Verbakel^{27

28}, Theo J Verheij²⁹

Affiliations

¹ Public Health Ontario, 480 University Ave, Ste 300, Toronto, ON, M5G 1V2, Canada. Kevin.Schwartz@oahpp.ca.
² Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. Kevin.Schwartz@oahpp.ca.
³ Unity Health Toronto, Toronto, Canada. Kevin.Schwartz@oahpp.ca.
⁴ Public Health Ontario, 480 University Ave, Ste 300, Toronto, ON, M5G 1V2, Canada.
⁵ Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
⁶ Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
⁷ Oaklands Health Centre, Holmfirth, UK.
⁸ Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
⁹ Centre for Practice-Changing Research (CPCR), Ottawa Hospital Research Institute, Ottawa, Canada.
¹⁰ Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK.
¹¹ Division of Clinical Epidemiology, University Hospital Basel and University of Basel, Basel, Switzerland.
¹² Department of Public Health and Primary Care, Center for Family Medicine UGent, Ghent University, Ghent, Belgium.
¹³ Primary Care Research Centre, University of Southampton, Southampton, UK.
¹⁴ Department of Medicine, University of Ottawa, Ottawa, Canada.
¹⁵ General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
¹⁶ Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Gothenburg, Sweden.
¹⁷ Centre for Antibiotic Resistance Research (CARe) at University of Gothenburg, Gothenburg, Sweden.
¹⁸ Department of General Practice, Antibiotic Centre for Primary Care, Institute of Health and Society, University of Oslo, Oslo, Norway.
¹⁹ Women's College Hospital, Toronto, Canada.
²⁰ Primary Care and Interventions Unit, UK Health Security Agency, Gloucester, England.
²¹ Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
²² Primary Care Research Centre, University of Southampton, Southampton, England.
²³ School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
²⁴ APEMAC, Université de Lorraine, Nancy, France.
²⁵ CHRU-Nancy, Centre regional en antibiotherapie de la region Grand Est AntibioEst, Université de Lorraine, Nancy, France.
²⁶ Department of Public Health, Nice University Hospital, Nice, France.
²⁷ Department of Public Health and Primary Care, KU Leuven, Louvain, Belgium.
²⁸ NIHR Community Healthcare Medtech and IVD Cooperative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
²⁹ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.

PMID: 37516892
PMCID: PMC10387210
DOI: 10.1186/s13756-023-01279-z

Best practice guidance for antibiotic audit and feedback interventions in primary care: a modified Delphi study from the Joint Programming Initiative on Antimicrobial resistance: Primary Care Antibiotic Audit and Feedback Network (JPIAMR-PAAN)

Kevin L Schwartz et al. Antimicrob Resist Infect Control. 2023.

. 2023 Jul 29;12(1):72.

doi: 10.1186/s13756-023-01279-z.

Authors

Affiliations

¹ Public Health Ontario, 480 University Ave, Ste 300, Toronto, ON, M5G 1V2, Canada. Kevin.Schwartz@oahpp.ca.
² Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. Kevin.Schwartz@oahpp.ca.
³ Unity Health Toronto, Toronto, Canada. Kevin.Schwartz@oahpp.ca.
⁴ Public Health Ontario, 480 University Ave, Ste 300, Toronto, ON, M5G 1V2, Canada.
⁵ Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
⁶ Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
⁷ Oaklands Health Centre, Holmfirth, UK.
⁸ Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
⁹ Centre for Practice-Changing Research (CPCR), Ottawa Hospital Research Institute, Ottawa, Canada.
¹⁰ Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK.
¹¹ Division of Clinical Epidemiology, University Hospital Basel and University of Basel, Basel, Switzerland.
¹² Department of Public Health and Primary Care, Center for Family Medicine UGent, Ghent University, Ghent, Belgium.
¹³ Primary Care Research Centre, University of Southampton, Southampton, UK.
¹⁴ Department of Medicine, University of Ottawa, Ottawa, Canada.
¹⁵ General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
¹⁶ Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Gothenburg, Sweden.
¹⁷ Centre for Antibiotic Resistance Research (CARe) at University of Gothenburg, Gothenburg, Sweden.
¹⁸ Department of General Practice, Antibiotic Centre for Primary Care, Institute of Health and Society, University of Oslo, Oslo, Norway.
¹⁹ Women's College Hospital, Toronto, Canada.
²⁰ Primary Care and Interventions Unit, UK Health Security Agency, Gloucester, England.
²¹ Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
²² Primary Care Research Centre, University of Southampton, Southampton, England.
²³ School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
²⁴ APEMAC, Université de Lorraine, Nancy, France.
²⁵ CHRU-Nancy, Centre regional en antibiotherapie de la region Grand Est AntibioEst, Université de Lorraine, Nancy, France.
²⁶ Department of Public Health, Nice University Hospital, Nice, France.
²⁷ Department of Public Health and Primary Care, KU Leuven, Louvain, Belgium.
²⁸ NIHR Community Healthcare Medtech and IVD Cooperative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
²⁹ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.

PMID: 37516892
PMCID: PMC10387210
DOI: 10.1186/s13756-023-01279-z

Abstract

Background: Primary care is a critical partner for antimicrobial stewardship efforts given its high human antibiotic usage. Peer comparison audit and feedback (A&F) is often used to reduce inappropriate antibiotic prescribing. The design and implementation of A&F may impact its effectiveness. There are no best practice guidelines for peer comparison A&F in antibiotic prescribing in primary care.

Objective: To develop best practice guidelines for peer comparison A&F for antibiotic prescribing in primary care in high income countries by leveraging international expertise via the Joint Programming Initiative on Antimicrobial Resistance-Primary Care Antibiotic Audit and Feedback Network.

Methods: We used a modified Delphi process to achieve convergence of expert opinions on best practice statements for peer comparison A&F based on existing evidence and theory. Three rounds were performed, each with online surveys and virtual meetings to enable discussion and rating of each best practice statement. A five-point Likert scale was used to rate consensus with a median threshold score of 4 to indicate a consensus statement.

Results: The final set of guidelines include 13 best practice statements in four categories: general considerations (n = 3), selecting feedback recipients (n = 1), data and indicator selection (n = 4), and feedback delivery (n = 5).

Conclusion: We report an expert-derived best practice recommendations for designing and evaluating peer comparison A&F for antibiotic prescribing in primary care. These 13 statements can be used by A&F designers to optimize the impact of their quality improvement interventions, and improve antibiotic prescribing in primary care.

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Conflict of interest statement

The authors declare no competing interests.

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References

1. Murray CJL, Ikuta KS, Sharara F, Swetschinski L, Robles Aguilar G, Gray A, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399:629–655. doi: 10.1016/S0140-6736(21)02724-0. - DOI - PMC - PubMed
1. World Health Organization. Global Action Plan on Antimcrobial Resistance. Available online at: https://www.who.int/publications/i/item/9789241509763. Accessed 30 Aug 2022.
1. Gunnarsson R, Orda U, Elliott B, Heal C, Del Del Mar C. What is the optimal strategy for managing primary care patients with an uncomplicated acute sore throat? Comparing the consequences of nine different strategies using a compilation of previous studies. BMJ Open. 2022;12:e059069. doi: 10.1136/bmjopen-2021-059069. - DOI - PMC - PubMed
1. Public Health Agency of Canada. Canadian Antimicrobial Resistance Surveillance System Report. Available online at: https://www.canada.ca/en/public-health/services/publications/drugs-healt.... Accessed 30 Aug 2022.
1. King LM, Fleming-Dutra KE, Hicks LA. Advances in optimizing the prescription of antibiotics in outpatient settings. BMJ. 2018;363:k3047. doi: 10.1136/bmj.k3047. - DOI - PMC - PubMed

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[1] Murray CJL, Ikuta KS, Sharara F, Swetschinski L, Robles Aguilar G, Gray A, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399:629–655. doi: 10.1016/S0140-6736(21)02724-0. - DOI - PMC - PubMed

[2] Murray CJL, Ikuta KS, Sharara F, Swetschinski L, Robles Aguilar G, Gray A, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399:629–655. doi: 10.1016/S0140-6736(21)02724-0. - DOI - PMC - PubMed

[3] World Health Organization. Global Action Plan on Antimcrobial Resistance. Available online at: https://www.who.int/publications/i/item/9789241509763. Accessed 30 Aug 2022.

[4] World Health Organization. Global Action Plan on Antimcrobial Resistance. Available online at: https://www.who.int/publications/i/item/9789241509763. Accessed 30 Aug 2022.

[5] Gunnarsson R, Orda U, Elliott B, Heal C, Del Del Mar C. What is the optimal strategy for managing primary care patients with an uncomplicated acute sore throat? Comparing the consequences of nine different strategies using a compilation of previous studies. BMJ Open. 2022;12:e059069. doi: 10.1136/bmjopen-2021-059069. - DOI - PMC - PubMed

[6] Gunnarsson R, Orda U, Elliott B, Heal C, Del Del Mar C. What is the optimal strategy for managing primary care patients with an uncomplicated acute sore throat? Comparing the consequences of nine different strategies using a compilation of previous studies. BMJ Open. 2022;12:e059069. doi: 10.1136/bmjopen-2021-059069. - DOI - PMC - PubMed

[7] Public Health Agency of Canada. Canadian Antimicrobial Resistance Surveillance System Report. Available online at: https://www.canada.ca/en/public-health/services/publications/drugs-healt.... Accessed 30 Aug 2022.

[8] Public Health Agency of Canada. Canadian Antimicrobial Resistance Surveillance System Report. Available online at: https://www.canada.ca/en/public-health/services/publications/drugs-healt.... Accessed 30 Aug 2022.

[9] King LM, Fleming-Dutra KE, Hicks LA. Advances in optimizing the prescription of antibiotics in outpatient settings. BMJ. 2018;363:k3047. doi: 10.1136/bmj.k3047. - DOI - PMC - PubMed

[10] King LM, Fleming-Dutra KE, Hicks LA. Advances in optimizing the prescription of antibiotics in outpatient settings. BMJ. 2018;363:k3047. doi: 10.1136/bmj.k3047. - DOI - PMC - PubMed

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Best practice guidance for antibiotic audit and feedback interventions in primary care: a modified Delphi study from the Joint Programming Initiative on Antimicrobial resistance: Primary Care Antibiotic Audit and Feedback Network (JPIAMR-PAAN)

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Best practice guidance for antibiotic audit and feedback interventions in primary care: a modified Delphi study from the Joint Programming Initiative on Antimicrobial resistance: Primary Care Antibiotic Audit and Feedback Network (JPIAMR-PAAN)

Authors

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Conflict of interest statement

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