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Supporting the improvement and management of prescribing for urinary tract infections (SIMPle): protocol for a
Sinead Duane1, Aoife Callan, Sandra Galvin
1Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland. sinead.duane@nuigalway.ie.
Background:
The overuse of antimicrobials is recognized as the main selective pressure driving the emergence and spread of antimicrobial resistance in human bacterial pathogens. Urinary tract infections (UTIs) are among the most common infections presented in primary care and empirical antimicrobial treatment is currently recommended. Previous research has identified that a substantial proportion of Irish general practitioners (GPs) prescribe antimicrobials for UTIs that are not in accordance with the Guidelines for Antimicrobial Prescribing in Primary Care in Ireland. The aim of this trial is to design, implement and evaluate the effectiveness of a complex intervention on GP antimicrobial prescribing and adult (18 years of age and over) patients' antimicrobial consumption when presenting with a suspected UTI.
Methods/Design:
The Supporting the Improvement and Management of Prescribing for urinary tract infections (SIMPle) study is a three-armed intervention with practice-level randomization. Adult patients presenting with suspected UTIs in primary care will be included in the study.The intervention integrates components for both GPs and patients. For GPs the intervention includes interactive workshops, audit and feedback reports and automated electronic prompts summarizing recommended first-line antimicrobial treatment and, for one intervention arm, a recommendation to consider delayed antimicrobial treatment. For patients, multimedia applications and information leaflets are included. Thirty practices will be recruited to the study; laboratory data indicate that 2,038 patients will be prescribed an antimicrobial in the study. The primary outcome is a change in prescribing of first-line antimicrobials for UTIs in accordance with the Guidelines for Antimicrobial Prescribing in Primary Care in Ireland. The study will take place over 15 months with a six-month intervention period. Data will be collected through a remote electronic anonymized data-extraction system, a text-messaging system and GP and patient interviews and surveys. The intervention will be strengthened by the implementation of a social marketing framework and an economic evaluation.
Trial Registration:
This intervention is registered at ClinicalTrials.gov, ID NCT01913860.
Insights
This study evaluated a complex intervention to improve antimicrobial prescribing for urinary tract infections (UTIs) in Irish general practice. The goal was to reduce inappropriate antimicrobial use and promote adherence to national guidelines.
Area of Science:
- Infectious Diseases
- General Practice
- Health Services Research
Background:
- Antimicrobial resistance is a growing global health threat, driven by overuse of antimicrobials.
- Urinary tract infections (UTIs) are common in primary care, often treated empirically with antimicrobials.
- Suboptimal antimicrobial prescribing for UTIs is prevalent among Irish general practitioners (GPs), deviating from national guidelines.
Purpose of the Study:
- To design, implement, and evaluate a complex intervention aimed at improving GP antimicrobial prescribing for UTIs.
- To assess the intervention's effectiveness in reducing adult patients' antimicrobial consumption for suspected UTIs.
- To promote adherence to the Guidelines for Antimicrobial Prescribing in Primary Care in Ireland.
Main Methods:
- The Supporting the Improvement and Management of Prescribing for urinary tract infections (SIMPle) study is a three-armed, practice-level randomized trial.
- Intervention components include GP workshops, audit/feedback, electronic prompts, and patient-facing multimedia resources.
- Data collection involves electronic extraction, text messaging, and patient/GP interviews over 15 months.
Main Results:
- The primary outcome is the change in first-line antimicrobial prescribing for UTIs, aligned with national guidelines.
- The study aims to quantify the impact of the intervention on prescribing practices and patient consumption.
- Laboratory data suggest 2,038 patients will receive antimicrobials during the study period.
Conclusions:
- The SIMPle study will provide evidence on the effectiveness of a multifaceted intervention to optimize antimicrobial prescribing for UTIs in primary care.
- Findings will inform strategies to combat antimicrobial resistance by improving guideline adherence.
- The study incorporates a social marketing framework and economic evaluation for comprehensive assessment.
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