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

Abstract

Background Most effective strategies designed to improve antimicrobial prescribing have multiple approaches. We assessed the impact of the implementation of a rigorous antimicrobial guide and subsequent multifaceted interventions aimed at improving antimicrobial use in Primary Care. Methods A quasi-experimental study was designed. Interventions aimed at achieving a good implementation of the guide consisted of the development of electronic decision support tools, local training meetings, regional workshops, conferences, targets for rates of antibiotic prescribing linked to financial incentives, feedback on antibiotic prescribing, and the implementation of a structured educational antimicrobial stewardship program. Interventions started in 2011, and continued until 2018. Outcomes: rates of antibiotics use, calculated into defined daily doses per 1,000 inhabitants-day (DID). An interrupted time-series analysis was conducted. The study ran from January 2004 until December 2018.

Exploring Antimicrobial Stewardship Influential Interventions on Improving Antibiotic Utilization in Outpatient and Inpatient Settings: A Systematic Review and Meta-Analysis

“…The included studies have been classified into four groups: 13 articles involved IP settings without a pharmacist as a part of an AMS-MDT intervention [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ], 19 were carried out in IP settings with the inclusion of a pharmacist as a part of the intervention team [ 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ], eight articles engaged OP without a pharmacist [ 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ], while eight involved OP settings with a pharmacist [ 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 ]. Forty-one articles were from d...…”

Coping with ‘the grey area’ of antibiotic prescribing: a theory-informed qualitative study exploring family physician perspectives on antibiotic prescribing

“…Thus, antimicrobial stewardship efforts in the community should feature communications training and skills development to support physicians in navigating and negotiating with patients, rather than just reviewing the guideline recommendations for initiation and indication. Additionally, guidelines might be more helpful if they integrate advice for managing scenarios which commonly lead to diagnostic uncertainty and if they were accompanied by evidence-based implementation aids such as recommendations for when and how to implement delayed prescriptions [ 29 , 32 – 34 ]. This study suggests that the duration of antibiotics prescribed in outpatient clinic settings is most amenable to improvement, particularly for providers that had been in practice for longer [ 35 – 38 ].…”

Results of implementation of a pilot antimicrobial stewardship program (ASP) in Primary Care

“…El aumento de bacterias multirresistentes y las escasas perspectivas de desarrollo de nuevos antimicrobianos han dado lugar a los PROA 2 , siendo numerosas las intervenciones realizadas tanto a nivel hospitalario como ambulatorio 8,9 . Las bacterias multirresistentes son un gran problema en los hospitales, sin embargo, la reducción global de las resistencias bacterianas solamente puede lograrse mejorando el uso de antimicrobianos en la comunidad 8 .…”

“…En los EAP con PROA-AP, el número de pacientes tratados con amoxicilina-clavulánico disminuyó, hecho que podría explicar el aumento paralelo y significativo en el uso de otros antibióticos de espectro más reducido como las penicilinas sensibles a betalactamasas. Además, aumentó significativamente el ratio amoxicilina/amoxicilina-clavulánico, lo que explica un cambio de comportamiento tendiendo a preservar los antibióticos de mayor espectro 6,8,10 .…”