Abstract
BackgroundRational 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.MethodsThe 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.ResultsThe 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.ConclusionsSingle 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.
Highlights
Rational antibiotic prescribing is crucial to combat antibiotic resistance
Econometric framework Using an econometric analysis, we investigated the effects of the two interventions on prescriptions while controlling for the relationship between characteristics of the healthcare centers and prescription levels, in general, and the difference between private and public Primary HealthCare Center (PHCC)
The level of respiratory tract infection related antibiotic prescriptions per 100 infections was larger at private PHCCs
Summary
Rational antibiotic prescribing is crucial to combat antibiotic resistance. Optimal strategies to improve antibiotic use are not known. Antibiotics and other medicines are often prescribed too for a number of reasons, including the desire to have a good relationship with patients [6, 7], the belief that patients expect to receive medications [8,9,10,11,12], time pressure and inadequate policies or guidelines [13] ignorance among practitioners regarding the conditions leading to resistance [12] and the way the healthcare system works It may be less convenient for the physician to wait and see how an illness develops and whether there is need for antibiotics than to write a prescription right away [13]. Use of rapid diagnostic tests such as the concentration of C-reactive protein as a point-of-care test, and rapid antigen detection test for group A streptococci [19], and academic detailing, or face-to-face education [20], have been found to have a positive effect on appropriate prescribing of antibiotics compared with personnel meetings and educational materials
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