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Audit and feedback to improve antibiotic prescribing among community physicians in India: A quasi-experimental study
Kensheya Regena1, Aamina Hussain1, Vaithya Venkatraman Anantharaman1
1Department of Community Medicine, SRM Medical College Hospital and Research Centre, Kattankulathur, Chengalpattu, Tamil Nadu, India.
Background:
Irrational antibiotic use, especially in Indian community settings, is a major contributor to the growing global threat of antimicrobial resistance (AMR). Guidelines for rational prescribing are provided by the WHO AWaRe classification; however, its use in primary care is still restricted. An effective way to enhance prescribing practices is through audit and feedback. The purpose of this study was to assess community physicians' use of antibiotics, gauge their compliance with the AWaRe framework, and ascertain whether structured audit and feedback can encourage sensible prescribing and aid in the fight against AMR.
Materials And Methods:
The study was conducted in two phases from July 2022 to 2023 in Chengalpattu, Tamil Nadu. Phase 1 involved a cross-sectional review of 680 antibiotic prescriptions. In Phase 2, 28 community physicians participated in a quasi-experimental study using a validated structured questionnaire. Educational intervention and feedback were provided. Data were analyzed using SPSS version 26.0, and the Wilcoxon signed-rank test was applied with a significance level of P < 0.05.
Results:
Amoxicillin was the most commonly prescribed antibiotic (88.2%) out of 680 prescriptions, mostly for upper respiratory tract infections. While access-group medications like amoxicillin were more commonly used in rural areas, watch-group antibiotics like azithromycin were more frequently used in urban areas. Perception scores (19 to 16, P = 0.000) and knowledge (median: 26.5 to 20, P = 0.000) significantly improved after the audit and feedback intervention. Increased adherence to the WHO AWaRe classification was observed in post-intervention prescribing patterns, with a discernible shift towards community physicians' use of antibiotics sensibly, especially when treating acute respiratory infections.
Conclusion:
Enhancing antibiotic stewardship and encouraging rational prescribing among community physicians at the primary care level through audit and feedback is a practical and economical approach that can improve adherence to AWaRe classification and decrease inappropriate antibiotic use.
Insights
Audit and feedback improved antibiotic prescribing in primary care, enhancing adherence to WHO AWaRe guidelines and combating antimicrobial resistance (AMR). This practical approach promotes rational antibiotic use among community physicians.
Area of Science:
- Public Health
- Infectious Diseases
- Pharmacology
Background:
- Irrational antibiotic use in India fuels antimicrobial resistance (AMR).
- The WHO AWaRe classification aids rational prescribing but has limited primary care use.
- Audit and feedback are effective strategies to improve prescribing practices.
Purpose of the Study:
- Assess community physicians' antibiotic prescribing patterns.
- Evaluate compliance with the WHO AWaRe framework.
- Determine if audit and feedback improve prescribing and combat AMR.
Main Methods:
- Cross-sectional review of 680 prescriptions (Phase 1).
- Quasi-experimental study with 28 physicians, including questionnaires and educational intervention (Phase 2).
- Data analyzed using SPSS, with Wilcoxon signed-rank test (P < 0.05).
Main Results:
- Amoxicillin was most prescribed (88.2%), primarily for respiratory infections.
- Perception and knowledge scores significantly improved post-intervention (P=0.000).
- Adherence to WHO AWaRe classification increased, promoting sensible antibiotic use.
Conclusions:
- Audit and feedback are practical, economical for antibiotic stewardship.
- This approach enhances AWaRe adherence and reduces inappropriate antibiotic use.
- It supports rational prescribing at the primary care level to fight AMR.
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