Best Practice Guidance for Antibiotic Audit and Feedback interventions in Primary Care: a modified Delphi study from the Joint Programming Initiative on Antimicrobial Resistance - Primary Care Antibiotic Audit and Feedback Network (JPIAMR-PAAN)

Abstract

Background: Primary care is a critical partner for antimicrobial stewardship efforts given its high human antibiotic usage. Peer comparison audit and feedback (A&F) is often used to reduce inappropriate antibiotic prescribing. The design and implementation of A&F may impact its effectiveness. There are no best practice guidelines for peer comparison A&F in antibiotic prescribing in primary care. Objective: To develop best practice guidelines for peer comparison A&F for antibiotic prescribing in primary care in high income countries by leveraging international expertise via the Joint Programming Initiative on Antimicrobial Resistance – Primary Care Antibiotic Audit and Feedback Network (JPIAMR-PAAN). Methods: We used a modified Delphi process to achieve convergence of expert opinions on best practice statements for peer comparison A&F based on existing evidence and theory. Three rounds were performed, each with online surveys and virtual meetings to enable discussion and rating of each best practice statement. A five-point Likert scale was used to rate consensus with a median threshold score of 4 to indicate a consensus statement. Results: The final set of guidelines include 13 best practice statements in four categories: general considerations (n=3), selecting feedback recipients (n=1), data and indicator selection (n=4), and feedback delivery (n=5). Conclusion: We report an expert-derived best practice recommendations for designing and evaluating peer comparison A&F for antibiotic prescribing in primary care. These 13 statements can be used by A&F designers to optimize the impact of their quality improvement interventions, and improve antibiotic prescribing in primary care.

Antimicrobial Stewardship: A Correct Management to Reduce Sepsis in NICU Settings

“…A periodic review of drug prescriptions and feedback to the neonatologists are recommended to lead to correct education and lasting change over time [17]. These practices do not interfere with clinicians' sense of autonomy, although clearly shared perspectives and objectives between clinicians and members of the antimicrobial stewardship team are necessary in order to have adequate results [67].…”