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Published on: August 30, 2018
Improving antibiotic prescribing quality by an intervention embedded in the primary care practice accreditation: the
Alike W van der Velden1, Marijke M Kuyvenhoven2, Theo J M Verheij2
1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (STR 6.103), Heidelberglaan 100, 3584 CX Utrecht, The Netherlands a.w.vandervelden@umcutrecht.nl.
Objectives:
Antibiotic overprescribing is a significant problem. Multifaceted interventions improved antibiotic prescribing quality; their implementation and sustainability, however, have proved difficult. We analysed the effectiveness of an intervention embedded in the quality cycle of primary care practice accreditation on quantity and quality of antibiotic prescribing for respiratory tract and ear infections (RTIs).
Methods:
This was a pragmatic, cluster-randomized intervention trial in 88 Dutch primary care practices. The intervention (physician education and audit/feedback on antibiotic prescribing quantity and quality) was integrated in practice accreditation by defining an improvement plan with respect to antibiotic prescribing for RTIs. Numbers and types of dispensed antibiotics were analysed from 1 year prior to the intervention to 2 years after the intervention (pharmacy data). Overprescribing, underprescribing and non-first-choice prescribing for RTIs were analysed at baseline and 1 year later (self-registration).
Results:
There were significant differences between intervention and control practices in the changes in dispensed antibiotics/1000 registered patients (first year: -7.6% versus -0.4%, P = 0.002; second year: -4.3% versus +2%, P = 0.015), which was more pronounced for macrolides and amoxicillin/clavulanate (first year: -12.7% versus +2.9%, P = 0.001; second year: -7.8% versus +6.7%, P = 0.005). Overprescribing for RTIs decreased from 44% of prescriptions to 28% (P < 0.001). Most general practitioners (GPs) envisaged practice accreditation as a tool for guideline implementation.
Conclusions:
GP education and an audited improvement plan around antibiotics for RTIs as part of primary care practice accreditation sustainably improved antibiotic prescribing. Tools should be sought to further integrate and facilitate education and audit/feedback in practice accreditation.
Insights
Integrating physician education and audit into primary care accreditation significantly reduced antibiotic overprescribing for respiratory tract and ear infections. This quality improvement strategy proved sustainable, enhancing antibiotic stewardship in general practice.
Area of Science:
- Primary Care Medicine
- Infectious Diseases
- Health Services Research
Background:
- Antibiotic overprescribing is a major global health concern, contributing to antimicrobial resistance.
- Previous multifaceted interventions to improve antibiotic prescribing have faced challenges in implementation and long-term sustainability.
- Primary care practice accreditation offers a structured framework for quality improvement initiatives.
Purpose of the Study:
- To evaluate the effectiveness of an intervention integrated into primary care practice accreditation on the quantity and quality of antibiotic prescribing for respiratory tract and ear infections (RTIs).
- To assess the sustainability of this intervention over a two-year period post-implementation.
Main Methods:
- A pragmatic, cluster-randomized trial involving 88 Dutch primary care practices.
- The intervention combined physician education with audit/feedback on antibiotic prescribing, embedded within the practice accreditation quality cycle.
- Antibiotic dispensing data were analyzed for one year pre-intervention to two years post-intervention; prescribing quality (overprescribing, non-first-choice) was assessed at baseline and one year later.
Main Results:
- Intervention practices showed significant reductions in dispensed antibiotics per 1000 patients compared to control practices (-7.6% vs. -0.4% in year 1; -4.3% vs. +2% in year 2).
- Reductions were particularly notable for macrolides and amoxicillin/clavulanate.
- Overprescribing of antibiotics for RTIs decreased substantially from 44% to 28% in intervention practices.
Conclusions:
- Integrating physician education and an audited improvement plan for antibiotic prescribing into primary care practice accreditation effectively and sustainably improved prescribing practices.
- Practice accreditation serves as a valuable tool for implementing and sustaining guideline adherence for antibiotic use.
- Further development of tools to integrate education and audit/feedback within accreditation processes is recommended.
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