Perception of antimicrobial stewardship interventions in Swiss primary care: a mixed-methods survey

With most antibiotic prescriptions occurring in primary care, antimicrobial stewardship (AMS) interventions must be known, welcomed, and used by primary care physicians (PCPs).

The main objective of this study was to evaluate the present awareness about, use of, and perceived acceptability, appropriateness, and feasibility of a broad range of interventions.

A cross-sectional survey was distributed to Swiss PCPs from December 2023 to February 2024.

The survey focused on eight AMS interventions: shared decision-making tools, factsheets for physicians, Swiss Federal Office of Public Health (FOPH) information material, national antibiotic guidelines website, audit and feedback, communication skills training, as well as the use of point-of-care C-reactive protein (POC-CRP) and procalcitonin (POC-PCT) to guide prescription. PCPs' perceived acceptability, appropriateness, and feasibility were assessed using 5-point Likert scales. General expectations regarding AMS were evaluated via qualitative analysis of free-text answers.

Out of 7456 potentially eligible primary care physicians, 355 PCPs answered at least one question (response rate 4.7%). PCPs were most aware of biomarkers to guide antibiotic prescription in respiratory tract infections (RTIs), such as POC-PCT (67.6%) and POC-CRP (61.1%); the FOPH awareness campaign (57.3%); and the national guidelines website (52.7%). All interventions were rated as acceptable, appropriate, and feasible, with respective mean scores out of five of 3.89, 3.91, and 3.81.

Despite the high perceived acceptability, appropriateness, and feasibility of AMS interventions available for RTIs, their real-life impact may be hindered by insufficient awareness. Additional promotion of those tools could increase their uptake by physicians.