Interventions for prudent antibiotic use in primary healthcare: an econometric analysis

Abstract

Background Rational antibiotic prescribing is crucial to combat antibiotic resistance. Optimal strategies to improve antibiotic use are not known. Strama, the Swedish strategic program against antibiotic resistance, has been successful in reducing antibiotic prescription rates. This study investigates whether two specific interventions directed toward healthcare centers, an informational visit and a self-evaluation meeting, played a role in observed reduction in rates of antibiotic prescriptions in primary healthcare. Methods The study was a retrospective, observational, empirical analysis exploiting the variation in the timing of the interventions and considering past prescriptions through use of estimations from dynamic panel data models. Primary healthcare data from 2011 to 2014 were examined. Data were from public and private primary healthcare centers in western Sweden. The key variables were prescription of antibiotics and indicator variables for the two interventions. Results The first intervention, an educational information intervention, decreased the number of prescriptions among public healthcare centers, but this effect was only temporary. We found no proof that the second intervention, a self-evaluation meeting at the healthcare center, had an impact on the reduction of prescriptions. Conclusions Single educational interventions aimed at influencing rates of antibiotic prescriptions have limited impact. A multifaceted approach is needed in efforts to reduce the use of antibiotics in primary health care.

Antimicrobial Prescribing Confidence and Knowledge Regarding Drug Resistance: Perception of Medical Students in Malaysia and the Implications

“…The growing awareness of the clinical and economic costs of AMR have resulted in global and national action plans to reduce AMR coordinated by the WHO and others [16,[20][21][22]. This includes Malaysia, which has growing AMR rates and concerns with appropriate antimicrobial prescribing across sectors [20,[23][24][25][26][27][28] Improving medical students' knowledge regarding antibiotics and AMR are essential to enhance appropriate antimicrobial prescribing following graduation, achieved through ASPs and other programs [29][30][31][32]. A comprehensive understanding of the pathophysiology of diseases as well as clinical pharmacology and therapeutics, are also indispensable to improve their prescribing practices post-qualification along with quality targets [33][34][35][36].…”

Improving Pharmacists’ Awareness of Inadequate Antibiotic Use for URTIs through an Educational Intervention: A Pilot Study

“…The use of educational tools to improve antimicrobial stewardship has increased in the last years, with positive results regarding the decrease in prescription rates and inadequate prescriptions [ 17 , 30 , 31 , 32 ].…”

Non-prescription acquisition of antibiotics: Prevalence, motives, pathways and explanatory factors in the Swedish population

“…There are well-known structural problems in effecting and implementing such prescription regimes even when a mandatory prescription system is in place. For instance, a study in Catalonia in 2008 indicated a very high willingness of pharmacists to supply antibiotics without prescription, despite a legally strict prescription mandate [7] and ensuring that doctors adhere to prescription standards when patients request antibiotics is known to be challenging [8][9][10], linking to a general connection between antibiotic consumption volumes and corruption levels [11].…”