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

Area of Science:

• Primary care research
• Implementation science
• Antimicrobial stewardship

Background:

• Antimicrobial stewardship (AMS) strategies can reduce antibiotic use in primary care, but adoption remains low in England.
• An implementation intervention was co-developed to promote three AMS strategies: enhanced communication, delayed prescriptions, and point-of-care C-reactive protein tests (POC-CRPTs).

Purpose of the Study:

• To assess the use of a co-developed intervention in high-prescribing general practices.
• To evaluate the intervention's impact on antibiotic prescribing rates.

Main Methods:

• A 12-month remote intervention delivered via a website to nine high-prescribing practices.
• Comparison of routinely collected prescribing data between intervention and control practices.
• Qualitative assessment of professional experiences and intervention use through surveys and interviews.

Main Results:

• No significant effect of the intervention on antibiotic prescribing was observed.
• Substantial variation in engagement with intervention materials, influenced by 'antibiotic champions'' preconceptions and implementation capacity.
• Champions in five practices initiated changes for at least one AMS strategy, with POC-CRPTs being most frequently adopted, especially when managed by a single individual.

Conclusions:

• Clinicians require explicit instructions for adopting AMS strategies.
• Remote, passive delivery of AMS strategies is insufficient to alter prescribing habits.
• Monitoring initial clinician engagement and understanding is crucial for effective implementation and to prevent suboptimal use.