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

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...

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Autores principales: Tonkin-Crine, Sarah, McLeod, Monsey, Borek, Aleksandra J, Campbell, Anne, Anyanwu, Philip, Costelloe, Céire, Moore, Michael, Hayhoe, Benedict, Pouwels, Koen B, Roope, Laurence SJ, Morrell, Liz, Hopkins, Susan, Butler, Christopher C, Walker, Ann Sarah
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Royal College of General Practitioners 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9975978/
https://www.ncbi.nlm.nih.gov/pubmed/36823061
http://dx.doi.org/10.3399/BJGP.2022.0298
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author Tonkin-Crine, Sarah
McLeod, Monsey
Borek, Aleksandra J
Campbell, Anne
Anyanwu, Philip
Costelloe, Céire
Moore, Michael
Hayhoe, Benedict
Pouwels, Koen B
Roope, Laurence SJ
Morrell, Liz
Hopkins, Susan
Butler, Christopher C
Walker, Ann Sarah
author_facet Tonkin-Crine, Sarah
McLeod, Monsey
Borek, Aleksandra J
Campbell, Anne
Anyanwu, Philip
Costelloe, Céire
Moore, Michael
Hayhoe, Benedict
Pouwels, Koen B
Roope, Laurence SJ
Morrell, Liz
Hopkins, Susan
Butler, Christopher C
Walker, Ann Sarah
author_sort Tonkin-Crine, Sarah
collection PubMed
description 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.
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spelling pubmed-99759782023-03-02 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 Hayhoe, Benedict Pouwels, Koen B Roope, Laurence SJ Morrell, Liz Hopkins, Susan Butler, Christopher C Walker, Ann Sarah Br J Gen Pract Research 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. Royal College of General Practitioners 2023-02-21 /pmc/articles/PMC9975978/ /pubmed/36823061 http://dx.doi.org/10.3399/BJGP.2022.0298 Text en © The Authors https://creativecommons.org/licenses/by/4.0/This article is Open Access: CC BY 4.0 licence (http://creativecommons.org/licences/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ).
spellingShingle Research
Tonkin-Crine, Sarah
McLeod, Monsey
Borek, Aleksandra J
Campbell, Anne
Anyanwu, Philip
Costelloe, Céire
Moore, Michael
Hayhoe, Benedict
Pouwels, Koen B
Roope, Laurence SJ
Morrell, Liz
Hopkins, Susan
Butler, Christopher C
Walker, Ann Sarah
Implementing antibiotic stewardship in high-prescribing English general practices: a mixed-methods study
title Implementing antibiotic stewardship in high-prescribing English general practices: a mixed-methods study
title_full Implementing antibiotic stewardship in high-prescribing English general practices: a mixed-methods study
title_fullStr Implementing antibiotic stewardship in high-prescribing English general practices: a mixed-methods study
title_full_unstemmed Implementing antibiotic stewardship in high-prescribing English general practices: a mixed-methods study
title_short Implementing antibiotic stewardship in high-prescribing English general practices: a mixed-methods study
title_sort implementing antibiotic stewardship in high-prescribing english general practices: a mixed-methods study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9975978/
https://www.ncbi.nlm.nih.gov/pubmed/36823061
http://dx.doi.org/10.3399/BJGP.2022.0298
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