Antimicrobial Stewardship within the Digital Setting: A Quality Improvement Study – Interventions and Outcomes within a Digital-First General Practice in the UK

Abstract

Antimicrobial resistance is a local, national and global health priority. With the emergence of new infections as demonstrated by the COVID-19 pandemic, our ability to conserve the effectiveness of antimicrobials is crucial. Public Health England’s (PHE) UK 20-year vision for antimicrobial stewardship states that one of the key objectives over the next 20 years is to demonstrate the optimal use of antimicrobials. A digital approach to the delivery of primary care services provides significant advantages regarding accessibility and patient satisfaction. This is beneficial for patients in obtaining medical care at the point of need. However, there are concerns that such accessibility may provide an opportunity for increased and inappropriate antimicrobial prescribing. As a digital GP practice with over 100,000 registered NHS patients and a multi-disciplinary workforce of approximately 300 clinicians comprising of General Practitioners (GPs), Prescribing Pharmacists (PPs) and Advanced Nurse Prescribers (ANPs), it is essential that appropriate systems and processes are in place to support good antimicrobial stewardship. Monitoring of prescribing is a significant aspect of antimicrobial stewardship. At Babylon, we review our antibiotic prescribing across our private and NHS services in the UK. The results from monthly broad-spectrum antibiotic prescribing audits between April 2020 – October 2020 showed an average appropriate prescribing rate of 76.4%. It was identified that further improvements could be made by incorporating regular feedback to prescribers as part of the interventions used to support prescribing. A quality improvement study was undertaken to review the impact of prescriber feedback on appropriate prescribing of broad-spectrum antibiotics and audit results observed within the practice.