Impact of the COVID-19 Pandemic on Community Antibiotic Prescribing and Stewardship: A Qualitative Interview Study with General Practitioners in England

Abstract

The COVID-19 pandemic has had a profound impact on the delivery of primary care services. We aimed to identify general practitioners’ (GPs’) perceptions and experiences of how the COVID-19 pandemic influenced antibiotic prescribing and antimicrobial stewardship (AMS) in general practice in England. Twenty-four semi-structured interviews were conducted with 18 GPs at two time-points: autumn 2020 (14 interviews) and spring 2021 (10 interviews). Interviews were audio-recorded, transcribed and analysed thematically, taking a longitudinal approach. Participants reported a lower threshold for antibiotic prescribing (and fewer consultations) for respiratory infections and COVID-19 symptoms early in the pandemic, then returning to more usual (pre-pandemic) prescribing. They perceived the pandemic as having had less impact on antibiotic prescribing for urinary and skin infections. Participants perceived the changing ways of working and consulting (e.g., proportions of remote and in-person consultations) in addition to changing patient presentations and GP workloads as influencing the fluctuations in antibiotic prescribing. This was compounded by decreased engagement with, and priority of, AMS due to COVID-19-related urgent priorities. Re-engagement with AMS is needed, e.g., through reviving antibiotic prescribing feedback and targets/incentives. The pandemic disrupted, and required adaptations in, the usual ways of working and AMS. It is now important to identify opportunities, e.g., for re-organising ways of managing infections and AMS in the future.

Inappropriate Antibiotic Use in Zimbabwe in the COVID-19 Era: A Perfect Recipe for Antimicrobial Resistance

“…The ongoing pandemic has caused disruption of routine health services, leading to staff and resource redeployments to fight COVID-19 [ 38 ]. This has had the effect of overlooking and deprioritising AMS programmes that rely on multidisciplinary collaborations and the regular review of practices [ 39 ].…”

In-Hospital Antibiotic Use for COVID-19: Facts and Rationales Assessed through a Mixed-Methods Study

“…Previous qualitative studies regarding antibacterial drug use during COVID-19 were mostly developed in primary care settings where the clinical scenario along with the disease severity were completely different; therefore, we could not compare our findings regarding the complex rationale behind antibiotic prescription. However, a previous qualitative study published before the emergence of COVID-19 showed that physicians were likely to base their decisions to administer antimicrobial drugs based solely on clinical grounds, which were no longer appliable given the fact that the patient–physician interactions were severely shortened due to the risk of SARS-CoV-2 transmission [ 20 ]; this idea was also presented by Borek et al in a qualitative study which involved general practitioners from England [ 21 ]. Regarding the presence of lung consolidation, in the Estrada et al study [ 14 ], not only alveolar infiltrates but also interstitial infiltrates were linked to antibiotic prescriptions, while the presence of bilateral interstitial infiltrates were strongly associated with what was considered inappropriate antibiotic use in the study of Calderón-Parra et al [ 16 ].…”

The value, challenges and practical considerations of conducting qualitative research on antimicrobial stewardship in primary care

“…In primary care specifically, the COVID-19 pandemic added other steps to managing infections and consequently AMR; for example the nature of the COVID-19 symptoms and the use of remote care brought uncertainties in how to manage patients with RTIs and made decision processes on whether to prescribe antibiotics or not more challenging. 92 , 93 While some of these may have become a ‘new normal’, the long-term impact of these changes will still need to be explored. Qualitative research can contribute to understanding these changes through, for example, studying patients’ and clinicians’ views of managing infections in the post-pandemic world, views on AMR, the barriers and facilitators to use of point-of-care tests and the impact of disrupted services on delivery of care or help seeking.…”