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Implementing antibiotic stewardship in high-prescribing English general practices: a mixed-methods study

Tonkin-Crine, Sarah; McLeod, Monsey; Borek, Aleksandra J; Campbell, Anne; Anyanwu, Philip; Costelloe, Céire; Moore, Michael; ... Walker, Ann Sarah; + view all (2023) Implementing antibiotic stewardship in high-prescribing English general practices: a mixed-methods study. British Journal of General Practice , 73 (728) e164-e175. 10.3399/BJGP.2022.0298. Green open access

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Abstract

BACKGROUND: Trials have identified antimicrobial stewardship (AMS) strategies that effectively reduce antibiotic use in primary care. However, many are not commonly used in England. The authors co-developed an implementation intervention to improve use of three AMS strategies: enhanced communication strategies, delayed prescriptions, and point-of-care C-reactive protein tests (POC-CRPTs). AIM: To investigate the use of the intervention in high-prescribing practices and its effect on antibiotic prescribing. DESIGN AND SETTING: Nine high-prescribing practices had access to the intervention for 12 months from November 2019. This was primarily delivered remotely via a website with practices required to identify an 'antibiotic champion'. METHOD: Routinely collected prescribing data were compared between the intervention and the control practices. Intervention use was assessed through monitoring. Surveys and interviews were conducted with professionals to capture experiences of using the intervention. RESULTS: There was no evidence that the intervention affected prescribing. Engagement with intervention materials differed substantially between practices and depended on individual champions' preconceptions of strategies and the opportunity to conduct implementation tasks. Champions in five practices initiated changes to encourage use of at least one AMS strategy, mostly POC-CRPTs; one practice chose all three. POC-CRPTs was used more when allocated to one person. CONCLUSION: Clinicians need detailed information on exactly how to adopt AMS strategies. Remote, one-sided provision of AMS strategies is unlikely to change prescribing; initial clinician engagement and understanding needs to be monitored to avoid misunderstanding and suboptimal use.

Type: Article
Title: Implementing antibiotic stewardship in high-prescribing English general practices: a mixed-methods study
Open access status: An open access version is available from UCL Discovery
DOI: 10.3399/BJGP.2022.0298
Publisher version: https://doi.org/10.3399/BJGP.2022.0298
Language: English
Additional information: Copyright © The Authors. This article is Open Access: CC BY 4.0 licence (http://creativecommons.org/licences/by/4.0/).
Keywords: antibiotic prescribing, antimicrobial resistance, antimicrobialstewardship, behaviour change, communication, C-reactive protein, delayed prescription, implementation, point-of-care testing
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
URI: https://discovery.ucl.ac.uk/id/eprint/10157407
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