Improving the appropriateness of antimicrobial use in primary care after implementation of a local antimicrobial guide in both levels of care

Abstract

The realization of multifactorial interventions involving professionals from both levels of care could be an effective strategy to improve the use of antimicrobials in primary care.

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

“…Several initiatives have been introduced across countries over the years to reduce inappropriate prescribing of antibiotics among physicians especially for patients with URTIs in both high-income countries as well as LMICs 29,76,85,151,335 . The impact of some of these for high-income countries is contained in the Supplementary material for potential reference and adaptation to LMICs ( Supplementary Table E).…”

“…Specific QIs also include adherence to guidelines. Adherence to guidelines has been found to better represent the quality of prescribing in ambulatory care versus current WHO/INRUD criteria 271,313,335,348 . However, it is important that there is only one national reference guideline since where multiple guidelines exist contradictions can occur 236 .…”

“…However, it is important that there is only one national reference guideline since where multiple guidelines exist contradictions can occur 236 . Guidelines should be readily available and combined with educational inputs and auditing of antibiotic prescribing to reduce inappropriate use 57,250,270,313,335,349 . Regular updates of antibiotic guidelines are also essential to enhance their utilization and updates should be rapidly disseminated to achieve agreed goals.…”

Successful improvement of antibiotic prescribing at Primary Care in Andalusia following the implementation of an antimicrobial guide through multifaceted interventions: An interrupted time-series analysis

“…In our setting, reduction of overall antibiotic prescribing rate exceeding 20%, occurred immediately after the publication of the guide at a rate of 0.8-0.9 DID per year, and were significant, both at the local level and in the whole region. Further, lower rates of antibiotics were achieved, while the appropriateness of the antibiotics use, according to the patients and processes treated, improved [28]. The magnitude of the decrease was greater than that observed in other studies conducted in Primary Care (3-15%) [2,[5][6][7][8][9][10].…”

“…At the local level, in the Aljarafe Area, other interventions included in the local implementation plan were carried out, in addition to those implemented at the regional level. These interventions were described in more detail in a previous publication [28]. Additional details regarding interventions, specifying the professionals who performed each action and institutional support, can be found in Table 1, and a timeline is provided in the (S1 Fig).…”