Improving antibiotic prescribing quality in out-of-hours primary care: a mixed-methods study using participatory...

Area of Science:

• Primary Care Research
• Antimicrobial Stewardship
• Health Services Research

Background:

• Overprescription of antibiotics for respiratory tract infections (RTIs) is common in out-of-hours (OOH) primary care.
• Implementing interventions to improve antibiotic prescribing quality faces practical challenges.
• Participatory action research (PAR) offers a collaborative approach to implement and evaluate practice changes with local stakeholders.

Purpose of the Study:

• To assess the effectiveness of PAR in enhancing antibiotic prescribing quality for RTIs during OOH primary care.
• To identify key lessons learned from implementing PAR interventions in this setting.

Main Methods:

• A mixed-methods study employing a PAR approach across three OOH GP cooperatives (GPCs).
• Each GPC collaboratively developed multifaceted interventions using plan-do-study-act cycles to optimize antibiotic use for RTIs.
• Antibiotic prescribing quality indicators were quantified, and lessons learned were derived from qualitative process analysis.

Main Results:

• Interventions were co-created with GPs and tailored to local contexts, fostering stakeholder engagement and project ownership.
• Significant reductions in antibiotic prescribing were observed for tonsillitis, bronchitis, otitis media, and acute upper RTIs in one GPC.
• Across all three GPCs, the use of guideline-recommended antibiotics for otitis media showed a significant increase.

Conclusions:

• Multifaceted interventions implemented via PAR can effectively reduce overall antibiotic prescribing and increase guideline-adherent use for RTIs in OOH primary care.
• Co-creating context-specific interventions with GPs is feasible and promotes ownership.
• Challenges remain in engaging all targeted GPs, highlighting the need for sustained efforts in implementation.