Impact of a Multifaceted Antimicrobial Stewardship Intervention in a Primary Health Care Area: A Quasi-Experimental Study

Abstract

The aim of the study was to evaluate the impact of a multifaceted antimicrobial stewardship intervention on antibiotic consumption in a primary health care (PHC) area in Spain. Quasi-experimental study conducted in a PHC area with nine PHC centers, a 400-bed acute care teaching hospital, and 18 nursing homes serving a population of 260,561. The intervention was based on the 2016 CDC Core Elements of Outpatient Antibiotic Stewardship publication and targeted 130 PHC physicians, 41 PHC pediatricians, 19 emergency physicians, and 18 nursing home physicians. The components were commitment, actions for improving antibiotic prescribing, tracking and feedback, and education and experience. The primary outcome was overall antibiotic consumption. Secondary outcomes were consumption of antibiotics to treat pharyngotonsillitis, acute otitis media, acute sinusitis, acute bronchitis, and urinary tract infection (UTI), percentage of patients treated with specific antibiotics, and dispensing costs. Consumption was measured in defined daily doses per 1,000 inhabitants per day (DID) and compared pre-and postintervention (2016 vs. 2018). Overall antibiotic consumption decreased from 16.01 to 13.31 DID (−16.85%). Consumption of amoxicillin/clavulanic acid and quinolones decreased from 6.04 to 4.72 DID (−21.88%) and 1.64 to 1.23 DID (−25.06%), respectively. The percentage of patients treated with antibiotics decreased from 26.99 to 22.41%. The intervention resulted in cost savings of €72,673. Use of antibiotics to treat pharyngotonsillitis, UTI, and acute otitis media, sinusitis, and bronchitis decreased significantly. Our antimicrobial stewardship program led to a decrease in antibiotic consumption and significantly improved the use of antibiotics for the most prevalent PHC infections.

Educational Interventions to Reduce Prescription and Dispensing of Antibiotics in Primary Care: A Systematic Review of Economic Impact

“…The most common diseases were respiratory tract infections (RTIs) [ 39 , 51 , 53 , 55 , 56 , 61 , 62 , 63 , 66 ], and either upper-RTIs (URTI) [ 39 , 55 , 61 , 62 , 63 ] or lower-RTIs (LRTIs) [ 51 ]. Most studies included patients from all age groups [ 2 , 39 , 43 , 44 , 45 , 48 , 50 , 56 , 57 , 58 , 59 , 60 , 65 , 66 , 67 , 68 ], only five included adults [ 47 , 49 , 51 , 52 , 55 ], four children [ 53 , 61 , 62 , 63 ] and two older adults [ 38 , 40 , 41 , 42 , 46 , 54 , 64 , 69 ].…”

“…The educational interventions implementation period ranged from 14 days [ 53 ] to 8 years [ 45 ]. Some studies compared similar periods of different years [ 2 , 38 , 39 , 40 , 42 , 43 , 44 , 49 , 52 , 53 , 59 , 60 , 64 , 65 , 66 , 67 , 68 , 69 ], within the same year [ 63 ] or both situations [ 41 , 50 , 57 , 62 ]. Only eleven studies [ 39 , 42 , 52 , 53 , 56 , 57 , 58 , 59 , 62 , 66 , 69 ] performed a follow-up analysis.…”

Outpatient prescribing pattern for acute bronchitis in primary healthcare settings in China

“…Our results indicated that, in 2017, Chinese primary healthcare clinicians prescribed antibiotics for nearly half of outpatients with acute bronchitis, which was a lower rate than those in the studies conducted in Italy (73.5%) 13 , US (74%) 14 , Belgium (69.0%) 15 , Spain (58.6%) 16 , Japan (52.8%) 17 , and Netherlands (51.0%) 18 , and was also lower than previous studies in China (77.5–95.2%) 9 , 11 . However, our rate was slightly higher than the rate showed in the study conducted in Swiss (41.5%) 19 .…”

Antimicrobial Stewardship Practice in the Ambulatory Setting From a National Cohort

“…Although we identify high-priority areas for ambulatory ASPs, it is important to note that successful ASPs are multifaceted, as seen with our survey respondents reporting greater rates of effectiveness as more CDC Core Elements of Outpatient Antimicrobial Stewardship are met [ 16 , 25 , 26 ]. Likewise, March-López et al [ 25 ] report that a multilayered outpatient study using interventions in line with the CDC Core Elements resulted in a 17% reduction in overall antibiotic utilization. A key component of this success was dependent on the personnel support provided to the ASP.…”