Does locally relevant, real-time infection epidemiological data improve clinician management and antimicrobial prescribing in primary care? A systematic review

Lane, Ian C.; Bryce, Ashley; Ingle, Suzanne M

doi:10.1093/fampra/cmy008

Cited by 11 publications

(19 citation statements)

References 18 publications

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“…The characteristics of the included studies in the umbrella review are shown in Table 1 [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. The included systematic reviews encompassed 109 individual primary research studies with a range of publication dates (1992–2016).…”

Section: Resultsmentioning

confidence: 99%

“…To maximise benefits from implementing an intervention to change prescribing behaviour, interventions need to be tailored to the specific context to target the specific delivery method that is best for the specific group of clinicians [ 27 ]. Nonetheless, it may be possible to translate the comprehensive list of outcome measures across primary medical and dental care and to adapt them further across other primary healthcare settings.…”

Section: Discussionmentioning

confidence: 99%

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Measuring Antibiotic Stewardship Programmes and Initiatives: An Umbrella Review in Primary Care Medicine and a Systematic Review of Dentistry

et al. 2020

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Antibiotic stewardship aims to tackle the global problem of drug-resistant infections by promoting the responsible use of antibiotics. Most antibiotics are prescribed in primary care and widespread overprescribing has been reported, including 80% in dentistry. This review aimed to identify outcomes measured in studies evaluating antibiotic stewardship across primary healthcare. An umbrella review was undertaken across medicine and a systematic review in dentistry. Systematic searches of Ovid Medline, Ovid Embase and Web of Science were undertaken. Two authors independently selected and quality assessed the included studies (using Critical Appraisal Skills Programme for the umbrella review and Quality Assessment Tool for Studies with Diverse Designs for the systematic review). Metrics used to evaluate antibiotic stewardship programmes and interventions were extracted and categorized. Comparisons between medical and dental settings were made. Searches identified 2355 medical and 2704 dental studies. After screening and quality assessment, ten and five studies, respectively, were included. Three outcomes were identified across both medical and dental studies: All focused on antibiotic usage. Four more outcomes were found only in medical studies: these measured patient outcomes, such as adverse effects. To evaluate antibiotic stewardship programmes and interventions across primary healthcare settings, measures of antibiotic use and patient outcomes are recommended.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Measuring Antibiotic Stewardship Programmes and Initiatives: An Umbrella Review in Primary Care Medicine and a Systematic Review of Dentistry

et al. 2020

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“…Diagnostic uncertainty may be a key driver of antimicrobial prescription for common infections in primary care, especially when associated with the fear of liability and patient demands. Previous studies have suggested considering delaying antibiotic prescription in order to reduce antibiotic use when there is diagnostic uncertainty as well as uncertainty as to bacterial/viral etiology [18][19][20]. Physicians in primary care settings in Saudi Arabia have stated that they prescribe antibiotics for high fever in the absence of laboratory con rmation [21].…”

Section: Discussionmentioning

confidence: 99%

Antibiotic prescription in primary care from the perspective of family physicians: a qualitative study

Hosoglu

Claßen

2020

Preprint

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Background Antibiotic consumption rates increase worldwide steadily. Turkey is now top on the list of global consumption and a prototype of excessive use of antibiotics. In the last two-decades, family physicians (FPs) have become key figures in the healthcare system. The aim of this study is to understand the reasons for inappropriate prescription and to elicit suggestions for ways of improving antibiotic use in primary care from doctors themselves.Methods This is a qualitative study using semi-structured interviews with key individuals. Fourteen FPs from different parts of Turkey participated in these interviews. They were questioned on major indications for antibiotic prescription, reasons for inappropriate antibiotic prescription, obstacles to decision making in antibiotic use and their suggestions for improving antibiotic use. The interviews were recorded, transcribed, and analyzed for common themes. Thematic coding was used in the formulation of themes.Results Interviewees emphasized the coercive factors that lead to inappropriate antibiotic prescription: patient expectations, defensive medical decision making, constraints due to workload and limited access to laboratories. The most powerful suggestions for improving the quality of antibiotic prescription were public campaigns, improvements in the diagnostic infrastructures of primary care centers and enhancing the social status of FPs. The FPs expressed strong concerns related to the complaints that patients make to administrative bodies. Conclusions Physicians in primary care work under immense pressure stemming mainly from workload, patient expectations and obstacles to diagnostic processes. Improving the social status of physicians, increasing public awareness and the facilitation of diagnostic procedures were the methods suggested for increasing antibiotic prescription accuracy.

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“…One SR was on delayed antibiotic prescribing, 13 one SR was on delayed antibiotic prescribing and family medicine interventions, 14 and 11 SRs were on family medicine interventions. [15][16][17][18][19][20][21][22][23][24][25] Some primary studies were included in more than one SR. The 2 SRs on delayed antibiotic prescribing reported on 4 of the same RCTs.…”

Section: Study Designsmentioning

confidence: 99%

Interventions to Influence the Use of Antibiotics for Acute Upper Respiratory Tract Infections

Thompson¹,

McCormack²

2021

cjht

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Thirteen systematic reviews (SRs) were identified. Two of these SRs addressed delayed antibiotic prescribing and 12 of these SRs investigated family medicine interventions. Delayed antibiotic prescribing reduced antibiotic use for upper respiratory tract infections (URTIs) compared to immediate prescribing and did not appear to impact patient satisfaction or re-consultation rates; however, there was less evidence on clinical outcomes, health care utilization, or antibiotic resistance. One systematic review concluded that there was no difference between delayed and immediate antibiotics for many clinical outcomes, but that immediate antibiotics may modestly improve symptoms for acute otitis media (AOM) and sore throat compared with delayed antibiotics. Various family medicine interventions were evaluated; however, there were generally few relevant primary studies in each of these reviews for most of the interventions. Rapid or point-of-care tests to guide the treatment of URTIs appeared to reduce antibiotic prescribing compared to control or usual care; however, there was relatively little evidence on clinical outcomes for these tests. One systematic review on procalcitonin-guided treatment suggested that this intervention led to no difference in the number of days with restricted activities or rates of treatment failure compared to control, while another systematic review found that C-reactive protein (CRP) point-of-care tests to guide antibiotic prescribing resulted in no difference in recovery or time to resolution of the symptoms; however, this was based on only 2 randomized controlled trials (RCTs). Evidence was mixed on different patient- or provider-directed interventions, such as education, training, and tools. In some of the primary studies from the eligible SRs, these interventions reduced antibiotic prescribing; while in others, they had no effect on antibiotic prescribing.

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Does locally relevant, real-time infection epidemiological data improve clinician management and antimicrobial prescribing in primary care? A systematic review

Cited by 11 publications

References 18 publications

Measuring Antibiotic Stewardship Programmes and Initiatives: An Umbrella Review in Primary Care Medicine and a Systematic Review of Dentistry

Measuring Antibiotic Stewardship Programmes and Initiatives: An Umbrella Review in Primary Care Medicine and a Systematic Review of Dentistry

Antibiotic prescription in primary care from the perspective of family physicians: a qualitative study

Interventions to Influence the Use of Antibiotics for Acute Upper Respiratory Tract Infections

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