Development of an intervention to support the implementation of evidence-based strategies for optimising antibiotic prescribing in general practice

Abstract

Background Trials show that antimicrobial stewardship (AMS) strategies, including communication skills training, point-of-care C-reactive protein testing (POC-CRPT) and delayed prescriptions, help optimise antibiotic prescribing and use in primary care. However, the use of these strategies in general practice is limited and inconsistent. We aimed to develop an intervention to enhance uptake and implementation of these strategies in primary care. Methods We drew on the Person-Based Approach to develop an implementation intervention in two stages. (1) Planning and design: We defined the problem in behavioural terms drawing on existing literature and conducting primary qualitative research (nine focus groups) in high-prescribing general practices. We identified ‘guiding principles’ with intervention objectives and key features and developed logic models representing intended mechanisms of action. (2) Developing the intervention: We created prototype intervention materials and discussed and refined these with input from 13 health professionals and 14 citizens in two sets of design workshops. We further refined the intervention materials following think-aloud interviews with 22 health professionals. Results Focus groups highlighted uncertainties about how strategies could be used. Health professionals in the workshops suggested having practice champions, brief summaries of each AMS strategy and evidence supporting the AMS strategies, and they and citizens gave examples of helpful communication strategies/phrases. Think-aloud interviews helped clarify and shorten the text and user journey of the intervention materials. The intervention comprised components to support practice-level implementation: antibiotic champions, practice meetings with slides provided, and an ‘implementation support’ website section, and components to support individual-level uptake: website sections on each AMS strategy (with evidence, instructions, links to electronic resources) and material resources (patient leaflets, POC-CRPT equipment, clinician handouts). Conclusions We used a systematic, user-focussed process of developing a behavioural intervention, illustrating how it can be used in an implementation context. This resulted in a multicomponent intervention to facilitate practice-wide implementation of evidence-based strategies which now requires implementing and evaluating. Focusing on supporting the uptake and implementation of evidence-based strategies to optimise antibiotic use in general practice is critical to further support appropriate antibiotic use and mitigate antimicrobial resistance.

Implementing antibiotic stewardship in high-prescribing English general practices: a mixed-methods study

“…The authors of the current study co-developed an implementation intervention 15 to support the use of three AMS strategies: enhanced communication skills with or without a patient leaflet; delayed prescriptions; and POC-CRPTs. …”

“…Printed copies of patient leaflets and clinician handouts were provided. 15 Practice teams were advised to use the intervention materials, as they wished, and encouraged to have follow-up practice meetings. Teams were able to select which AMS strategies they wished to implement.…”

“…We co-developed an implementation intervention 15 to support the use of three AMS strategies; enhanced communication skills +/-patient leaflet, delayed prescriptions and POC-CRPT. The intervention was designed to be brief, provide choice in uptake of strategies and be delivered remotely with minimal input from the research team.…”

“…The authors of the current study previously described the co-development of an implementation intervention, with primary care staff and citizens, for general practice to help improve use of three AMS strategies that previous trials have shown to be effective and safe. 15 This study aimed to investigate the use of the implementation intervention in high-prescribing practices and its effect on antibiotic prescribing.…”

How can behavioural science contribute to qualitative research on antimicrobial stewardship in primary care?

“…For example, the PBA was used to develop an intervention to promote the implementation of evidence-based AMS interventions underused in English primary care (Figure 3 ). 92 …”