Educational interventions to improve prescription and dispensing of antibiotics: a systematic review

Abstract

BackgroundExcessive and inappropriate antibiotic use contributes to growing antibiotic resistance, an important public-health problem. Strategies must be developed to improve antibiotic-prescribing. Our purpose is to review of educational programs aimed at improving antibiotic-prescribing by physicians and/or antibiotic-dispensing by pharmacists, in both primary-care and hospital settings.MethodsWe conducted a critical systematic search and review of the relevant literature on educational programs aimed at improving antibiotic prescribing and dispensing practice in primary-care and hospital settings, published in January 2001 through December 2011.ResultsWe identified 78 studies for analysis, 47 in primary-care and 31 in hospital settings. The studies differed widely in design but mostly reported positive results. Outcomes measured in the reviewed studies were adherence to guidelines, total of antibiotics prescribed, or both, attitudes and behavior related to antibiotic prescribing and quality of pharmacy practice related to antibiotics. Twenty-nine studies (62%) in primary care and twenty-four (78%) in hospital setting reported positive results for all measured outcomes; fourteen studies (30%) in primary care and six (20%) in hospital setting reported positive results for some outcomes and results that were not statistically influenced by the intervention for others; only four studies in primary care and one study in hospital setting failed to report significant post-intervention improvements for all outcomes. Improvement in adherence to guidelines and decrease of total of antibiotics prescribed, after educational interventions, were observed, respectively, in 46% and 41% of all the reviewed studies. Changes in behaviour related to antibiotic-prescribing and improvement in quality of pharmacy practice was observed, respectively, in four studies and one study respectively.ConclusionThe results show that antibiotic use could be improved by educational interventions, being mostly used multifaceted interventions.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-1276) contains supplementary material, which is available to authorized users.

Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future

“…Multiple strategies are typically needed to reduce unnecessary prescribing and dispensing of antibiotics in ambulatory care among all key stakeholder groups including patients, parents, community pharmacists and physicians 29,40,52,60,70,71,74,97,154,243 . This reflects the complexity of the situation, the different beliefs of key stakeholder groups and often multiple organizations and personnel within a country involved with improving antibiotic utilization and reducing AMR rates 244 .…”

“…We are aware that an appreciable number of publications and ongoing research already exist discussing potential ways to improve antibiotic utilization especially in LMICs, which includes improved surveillance 29,45,61,66,85,100,119,120,151,152 . A number of systematic reviews regarding the management of URTIs and ways to improve both the prescribing and dispensing of antibiotics for patients with URTIs have also been published 21,43,45,57,61,74,85,108,153,154 . These include systematic reviews determining possible reasons behind dispensing antibiotics without a prescription 141,155 , patient-related determinants regarding antibiotic use 156 , and reviews assessing the influence of targeted communications among patients to reduce excessive antibiotic use 157 .…”

Impact of an antimicrobial resistance control program: pre- and post-training antibiotic use in children with typhoid fever

“…Similarly, a systematic review by Roqueet al reported that quality of antibiotic use improved after clinician education (92% of the total studies). 9 Training in Dr. Soetomo Hospital was provided in the form of seminars, workshops, and interactive problem solving in small groups. These methods were chosen in order to improve retention.…”

The Evidence-Based Development of an Intervention to Improve Clinical Health Literacy Practice

“…Key facilitators for effective health professional training relevant to the intervention being developed were inclusion of mixed teaching methods such as a mixture of didactic teaching and practical/participatory methods [18,[24][25][26][27][28][29][30]; including use of simulated patients [24] and small group learning [24]; building on practitioners current skills and knowledge [27]; practitioner commitment to change practice [29,30] and identifying and discussing ways of addressing barriers to change [27]; and involving local opinion leaders [28]. One paper reported systematic identification of patients most likely to benefit [31] as being a facilitator for change.…”