Converting Habits of Antibiotic Use for Respiratory Tract Infections in German Primary Care (Change-3) - Process Evaluation of a Complex Intervention

Abstract

Background: Antimicrobial resistance remains a global challenge. In Germany, the national health agenda supports measures that enhance the rational use of antibiotics. The study “Converting Habits of Antibiotic Use for Respiratory Tract Infections in German Primary Care (CHANGE-3)” aimed at a sustainable reduction of antimicrobial resistance through the conversion of habits of antibiotics use and an increase in health literacy in primary care patients, practice teams, and in the general public. Embedded in a cluster-randomized trial of a multifaceted implementation program, a process evaluation focused on the uptake of program components to assess the fidelity of the implementation program in the CHANGE-3 study and to understand utilization of its educational components. Methods: A mix of qualitative and quantitative methods was used. Semi-structured telephone interviews were conducted with General Practitioners, Medical Assistants, patients treated for respiratory tract infection and outreach visitors who had carried out individual outreach visits. A two-wave written survey (T1: 5 months after start, T2: 16 months after start) was conducted in general practitioners and medical assistants. Qualitative data were analyzed using thematic framework analysis. Descriptive statistics were used to analyze survey data. Results: Uptake of intervention components was heterogenous. Across all components, the uptake reported by General Practitioners varied from 20% to 88% at T1 and 31% to 63% at T2. Medical Assistants reported uptake from 22% to 70% at T1 and 6% to 69% at T2. Analog paper-based components could by and large be integrated in daily practice (64% to 90% in T1; 41% to 93% in T2), but uptake of digital components was low. A one-time outreach visit provided thematic information and feedback regarding actual prescribing, but due to time constraints were received with reluctance by practice teams. Patients were largely unaware of program components, but assumed that information and education could promote health literacy regarding antibiotics use. Conclusions: The uptake of program components was heterogeneous, with lowest uptake of the digital components. Potential effects of the implementation program (i.e. reduced antibiotics prescribing), will warrant careful analysis of contributing program components. Trial registration: ISRCTN, ISRCTN15061174. Registered 13 July 2018 – Retrospectively registered, http://www.isrctn.com/ISRCTN15061174