Abstract
Many antimicrobial stewardship (AMS) interventions have been implemented in England, facilitating decreases in antibiotic prescribing. Nevertheless, there is substantial variation in antibiotic prescribing across England and some healthcare organizations remain high prescribers of antibiotics. This study aimed to identify ways to improve AMS interventions to further optimize antibiotic prescribing in primary care in England. Stakeholders representing different primary care settings were invited to, and 15 participated in, a focus group or telephone interview to identify ways to improve existing AMS interventions. Forty-five intervention suggestions were generated and 31 were prioritized for inclusion in an online survey. Fifteen stakeholders completed the survey appraising each proposed intervention using the pre-defined APEASE (i.e., Affordability, Practicability, Effectiveness, Acceptability, Safety, and Equity) criteria. The highest-rated nine interventions were prioritized as most promising and feasible, including: quality improvement, multidisciplinary peer learning, appointing AMS leads, auditing individual-level prescribing, developing tools for prescribing audits, improving inductions for new prescribers, ensuring consistent local approaches to antibiotic prescribing, providing online AMS training to all patient-facing staff, and increasing staff time available for AMS work with standardizing AMS-related roles. These prioritized interventions could be incorporated into existing national interventions or developed as stand-alone interventions to help further optimize antibiotic prescribing in primary care in England.
Highlights
Conserving antibiotics by optimizing antibiotic prescribing to reduce the spread of antimicrobial resistance is a key public health priority both globally and nationally in the UK [1,2,3]
The interventions assessed and prioritized by the stakeholders build on antimicrobial stewardship (AMS) interventions currently implemented in England [10] and effective interventions tested in UK-based research studies [11]
Our findings suggest that these interventions might be less promising ways to optimize antibiotic use for
Summary
Conserving antibiotics by optimizing antibiotic prescribing to reduce the spread of antimicrobial resistance is a key public health priority both globally and nationally in the UK [1,2,3]. While antibiotic prescribing in primary care in England reduced by 13.2% between 2013 and 2017 [4], antibiotic use in the community is still higher than in several other European countries [6]. There is a considerable variation in antibiotic prescribing between general practices, with many practices remaining high prescribers [7], and between practices and other types of healthcare providers in the community (e.g., out-of-hours, urgent care) [4]. Changing healthcare professionals’ (HCP) prescribing behaviors can help reduce antibiotic use and many factors influencing antibiotic prescribing for RTIs in primary care have been identified [9,10,11,12,13]
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