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Published in: Antimicrobial Resistance & Infection Control 1/2021

Open Access 01-12-2021 | Antibiotic | Research

Evaluation of a multimodal intervention to promote rational antibiotic use in primary care

Authors: Inga Petruschke, Florian Salm, Michelle Kaufmann, Antje Freytag, Jochen Gensichen, Michael Behnke, Tobias Siegfried Kramer, Regina Hanke, Petra Gastmeier, Sandra Schneider, RAI Study Group

Published in: Antimicrobial Resistance & Infection Control | Issue 1/2021

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Abstract

Background

Increasing antimicrobial resistance is a serious societal challenge affecting outpatient, inpatient and veterinary care. The German One-Health project, RAI (Rational use of Antibiotics via Information and Communication) addresses all three sectors. In the outpatient sector, General Practitioners (GPs) are the main prescribers of antibiotics and were therefore, targeted for this study. A multimodal intervention focusing on Acute Respiratory Tract infections (ARI) was designed and implemented. The aim of this study was to evaluate acceptance, rating and the self-reported impact of the intervention among GPs.

Methods

The intervention offered six tools: a GP training on rational antibiotic use, an app for self-monitoring, a leaflet and a set of posters (both for use as information materials in waiting rooms) and both digital and printed information prescriptions (material for ‘prescribing’ information instead of an antibiotic to the patient). The tools could be used according to individual preferences. The intervention was conducted between August 2016 and July 2017. Following the intervention, a three pages anonymous questionnaire was sent to all 271 participants. Items covered socio-demographic and professional background, use and judgement of the intervention tools (6 point Likert scale), impact of the intervention tools (4 point Likert scale).

Results

The response rate was 39% (n = 107). On average, respondents used 3.1 of the six available tools, with printed information prescriptions used most frequently (79%). Digital information prescriptions were used more frequently by men than by women (OR 2.8; 95% CI 1.16–7.24; p = 0.02). Eighty-seven percent of respondents stated that information prescriptions supported doctor-patient communication. In a comparison of the overall impression of the different intervention tools the GP training on rational antibiotic use was rated best (1.67 on a 6 point scale with 1 = highest, 6 = lowest) and most often noted as having had a “strong” or “very strong” impact on personal antibiotic prescribing behavior.

Conclusions

The multimodal intervention addressing education and communication was well accepted among GPs and could help in fostering rational use of antibiotics in primary care.
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Literature
1.
go back to reference Holmes AH, et al. Understanding the mechanisms and drivers of antimicrobial resistance. Lancet. 2016;387(10014):176–87.CrossRef Holmes AH, et al. Understanding the mechanisms and drivers of antimicrobial resistance. Lancet. 2016;387(10014):176–87.CrossRef
2.
go back to reference GERMAP 2015—Report on the consumption of antimicrobials and the spread of antimicrobial resistance in human and veterinary medicine in Germany. Federal Office of Consumer Protection and Food Safety, Paul-Ehrlich-Gesellschaft für Chemotherapie e.V.: Rheinbach 2016. GERMAP 2015—Report on the consumption of antimicrobials and the spread of antimicrobial resistance in human and veterinary medicine in Germany. Federal Office of Consumer Protection and Food Safety, Paul-Ehrlich-Gesellschaft für Chemotherapie e.V.: Rheinbach 2016.
3.
go back to reference Singer, A., et al., Informing antimicrobial stewardship: factors associated with inappropriate antimicrobial prescribing in primary care. Fam Pract, 2017. Singer, A., et al., Informing antimicrobial stewardship: factors associated with inappropriate antimicrobial prescribing in primary care. Fam Pract, 2017.
4.
go back to reference Gulliford MC, et al. Continued high rates of antibiotic prescribing to adults with respiratory tract infection: survey of 568 UK general practices. BMJ Open. 2014;4(10):e006245.CrossRef Gulliford MC, et al. Continued high rates of antibiotic prescribing to adults with respiratory tract infection: survey of 568 UK general practices. BMJ Open. 2014;4(10):e006245.CrossRef
5.
go back to reference Kraus EM, et al. Antibiotic prescribing for acute lower respiratory tract infections (LRTI)—guideline adherence in the German primary care setting: an analysis of routine data. PLoS ONE. 2017;12(3):e0174584.CrossRef Kraus EM, et al. Antibiotic prescribing for acute lower respiratory tract infections (LRTI)—guideline adherence in the German primary care setting: an analysis of routine data. PLoS ONE. 2017;12(3):e0174584.CrossRef
6.
go back to reference Zweigner, J., et al., Rate of antibiotic prescriptions in German outpatient care - are the guidelines followed or are they still exceeded? GMS Hyg Infect Control, 2018. 13: p. Doc04. Zweigner, J., et al., Rate of antibiotic prescriptions in German outpatient care - are the guidelines followed or are they still exceeded? GMS Hyg Infect Control, 2018. 13: p. Doc04.
7.
go back to reference Aabenhus R, et al. Clinical indications for antibiotic use in Danish general practice: results from a nationwide electronic prescription database. Scand J Prim Health Care. 2017;35(2):162–9.CrossRef Aabenhus R, et al. Clinical indications for antibiotic use in Danish general practice: results from a nationwide electronic prescription database. Scand J Prim Health Care. 2017;35(2):162–9.CrossRef
8.
go back to reference Petersen I, Hayward AC. Antibacterial prescribing in primary care. J Antimicrob Chemother. 2007;60(Suppl 1):i43-47.CrossRef Petersen I, Hayward AC. Antibacterial prescribing in primary care. J Antimicrob Chemother. 2007;60(Suppl 1):i43-47.CrossRef
9.
go back to reference Smith SM, et al. Antibiotics for acute bronchitis. Cochrane Database Syst Rev. 2014;3:Cd00245. Smith SM, et al. Antibiotics for acute bronchitis. Cochrane Database Syst Rev. 2014;3:Cd00245.
10.
go back to reference Schneider S, et al. Antibiotic intake and resistance development—knowledge, experience and behavior among the German general population. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2016;59(9):1162–70.CrossRef Schneider S, et al. Antibiotic intake and resistance development—knowledge, experience and behavior among the German general population. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2016;59(9):1162–70.CrossRef
11.
go back to reference Davis, M.E., et al., Exploring Patient Awareness and Perceptions of the Appropriate Use of Antibiotics: A Mixed-Methods Study. Antibiotics (Basel), 2017. 6(4). Davis, M.E., et al., Exploring Patient Awareness and Perceptions of the Appropriate Use of Antibiotics: A Mixed-Methods Study. Antibiotics (Basel), 2017. 6(4).
12.
go back to reference Salm F, et al. Antibiotic use, knowledge and health literacy among the general population in Berlin, Germany and its surrounding rural areas. PLoS ONE. 2018a;13(2):e0193336.CrossRef Salm F, et al. Antibiotic use, knowledge and health literacy among the general population in Berlin, Germany and its surrounding rural areas. PLoS ONE. 2018a;13(2):e0193336.CrossRef
13.
go back to reference Macfarlane J, et al. Influence of patients’ expectations on antibiotic management of acute lower respiratory tract illness in general practice: questionnaire study. BMJ. 1997;315(7117):1211–4.CrossRef Macfarlane J, et al. Influence of patients’ expectations on antibiotic management of acute lower respiratory tract illness in general practice: questionnaire study. BMJ. 1997;315(7117):1211–4.CrossRef
14.
go back to reference Brabers AE, et al. Is there a conflict between general practitioners applying guidelines for antibiotic prescribing and including their patients’ preferences? Patient Prefer Adherence. 2018;12:9–19.CrossRef Brabers AE, et al. Is there a conflict between general practitioners applying guidelines for antibiotic prescribing and including their patients’ preferences? Patient Prefer Adherence. 2018;12:9–19.CrossRef
15.
go back to reference Salm F, et al. Antibiotic prescribing behavior among general practitioners—a questionnaire-based study in Germany. BMC Infect Dis. 2018b;18(1):208.CrossRef Salm F, et al. Antibiotic prescribing behavior among general practitioners—a questionnaire-based study in Germany. BMC Infect Dis. 2018b;18(1):208.CrossRef
16.
go back to reference Hueber S, et al. “What they see is what you get”: prescribing antibiotics for respiratory tract infections in primary care: Do high prescribers diagnose differently? An analysis of German routine data. PLoS ONE. 2017;12(12):e0188521.CrossRef Hueber S, et al. “What they see is what you get”: prescribing antibiotics for respiratory tract infections in primary care: Do high prescribers diagnose differently? An analysis of German routine data. PLoS ONE. 2017;12(12):e0188521.CrossRef
17.
go back to reference Silverman M, et al. Antibiotic prescribing for nonbacterial acute upper respiratory infections in elderly persons. Ann Intern Med. 2017;166(11):765–74.CrossRef Silverman M, et al. Antibiotic prescribing for nonbacterial acute upper respiratory infections in elderly persons. Ann Intern Med. 2017;166(11):765–74.CrossRef
18.
go back to reference European Centre for Disease Prevention and Control, Antimicrobial resistance and healthcare-associated infections 2014 In: ECDC. Annual epidemiological report., in ECDC. 2015: Stockholm. European Centre for Disease Prevention and Control, Antimicrobial resistance and healthcare-associated infections 2014 In: ECDC. Annual epidemiological report., in ECDC. 2015: Stockholm.
19.
go back to reference Altiner A, et al. Reducing antibiotic prescriptions for acute cough by motivating GPs to change their attitudes to communication and empowering patients: a cluster-randomized intervention study. J Antimicrob Chemother. 2007;60(3):638–44.CrossRef Altiner A, et al. Reducing antibiotic prescriptions for acute cough by motivating GPs to change their attitudes to communication and empowering patients: a cluster-randomized intervention study. J Antimicrob Chemother. 2007;60(3):638–44.CrossRef
20.
go back to reference Barreto T, Lin KW. Interventions to facilitate shared decision making to address antibiotic use for acute respiratory tract infections in primary care. Am Fam Physician. 2017;95(1):11–2.PubMed Barreto T, Lin KW. Interventions to facilitate shared decision making to address antibiotic use for acute respiratory tract infections in primary care. Am Fam Physician. 2017;95(1):11–2.PubMed
21.
go back to reference Coxeter P, et al. Interventions to facilitate shared decision making to address antibiotic use for acute respiratory infections in primary care. Cochrane Database Syst Rev. 2015;11:010907. Coxeter P, et al. Interventions to facilitate shared decision making to address antibiotic use for acute respiratory infections in primary care. Cochrane Database Syst Rev. 2015;11:010907.
22.
go back to reference de Bont EG, et al. Patient information leaflets to reduce antibiotic use and reconsultation rates in general practice: a systematic review. BMJ Open. 2015;5(6):e007612.CrossRef de Bont EG, et al. Patient information leaflets to reduce antibiotic use and reconsultation rates in general practice: a systematic review. BMJ Open. 2015;5(6):e007612.CrossRef
23.
go back to reference Little P, et al. Delayed antibiotic prescribing strategies for respiratory tract infections in primary care: pragmatic, factorial, randomised controlled trial. BMJ. 2014;348:g1606.CrossRef Little P, et al. Delayed antibiotic prescribing strategies for respiratory tract infections in primary care: pragmatic, factorial, randomised controlled trial. BMJ. 2014;348:g1606.CrossRef
24.
go back to reference Hoye S, Gjelstad S, Lindbaek M. Effects on antibiotic dispensing rates of interventions to promote delayed prescribing for respiratory tract infections in primary care. Br J Gen Pract. 2013;63(616):e777–86.CrossRef Hoye S, Gjelstad S, Lindbaek M. Effects on antibiotic dispensing rates of interventions to promote delayed prescribing for respiratory tract infections in primary care. Br J Gen Pract. 2013;63(616):e777–86.CrossRef
25.
go back to reference Hallsworth M, et al. Provision of social norm feedback to high prescribers of antibiotics in general practice: a pragmatic national randomised controlled trial. Lancet. 2016;387(10029):1743–52.CrossRef Hallsworth M, et al. Provision of social norm feedback to high prescribers of antibiotics in general practice: a pragmatic national randomised controlled trial. Lancet. 2016;387(10029):1743–52.CrossRef
26.
go back to reference Urbiztondo, I., et al., Decreasing Inappropriate Use of Antibiotics in Primary Care in Four Countries in South America-Cluster Randomized Controlled Trial. Antibiotics (Basel), 2017. 6(4). Urbiztondo, I., et al., Decreasing Inappropriate Use of Antibiotics in Primary Care in Four Countries in South America-Cluster Randomized Controlled Trial. Antibiotics (Basel), 2017. 6(4).
27.
go back to reference O’Connor R, et al. Antibiotic use for acute respiratory tract infections (ARTI) in primary care; what factors affect prescribing and why is it important? A narrative review. Ir J Med Sci. 2018;187(4):969–86.CrossRef O’Connor R, et al. Antibiotic use for acute respiratory tract infections (ARTI) in primary care; what factors affect prescribing and why is it important? A narrative review. Ir J Med Sci. 2018;187(4):969–86.CrossRef
28.
go back to reference Schneider, S., et al., Perceptions and attitudes regarding antibiotic resistance in Germany: a cross-sectoral survey amongst physicians, veterinarians, farmers and the general public. J Antimicrob Chemother, 2018. Schneider, S., et al., Perceptions and attitudes regarding antibiotic resistance in Germany: a cross-sectoral survey amongst physicians, veterinarians, farmers and the general public. J Antimicrob Chemother, 2018.
30.
go back to reference Salm, F., S. Schneider, and P. Gastmeier, InfectControl 2020: rational antibiotic use by information and communication-the RAl project. Umweltmed—Hygiene—Arbeitsmed, 2017. 22: p. 301–4. Salm, F., S. Schneider, and P. Gastmeier, InfectControl 2020: rational antibiotic use by information and communication-the RAl project. Umweltmed—Hygiene—Arbeitsmed, 2017. 22: p. 301–4.
32.
go back to reference van Esch TEM, et al. Does shared decision-making reduce antibiotic prescribing in primary care? J Antimicrob Chemother. 2018;73(11):3199–205.CrossRef van Esch TEM, et al. Does shared decision-making reduce antibiotic prescribing in primary care? J Antimicrob Chemother. 2018;73(11):3199–205.CrossRef
33.
go back to reference McDonagh, M., et al., in Improving Antibiotic Prescribing for Uncomplicated Acute Respiratory Tract Infections. 2016: Rockville (MD). McDonagh, M., et al., in Improving Antibiotic Prescribing for Uncomplicated Acute Respiratory Tract Infections. 2016: Rockville (MD).
34.
go back to reference Lauridsen GB, et al. Consultation expectations among patients with respiratory tract infection symptoms. Dan Med J. 2017;64(6):1. Lauridsen GB, et al. Consultation expectations among patients with respiratory tract infection symptoms. Dan Med J. 2017;64(6):1.
35.
go back to reference Klingenberg A., B.T., Andres E., Kaufmann-Kolle P., Wambach V., Szescenyi J., Was wissen Patienten über Antibiotika, und wie häufig erwarten sie deren Verordnung? Z Allg Med, 2019. 95 (5): p. 198–201. Klingenberg A., B.T., Andres E., Kaufmann-Kolle P., Wambach V., Szescenyi J., Was wissen Patienten über Antibiotika, und wie häufig erwarten sie deren Verordnung? Z Allg Med, 2019. 95 (5): p. 198–201.
36.
go back to reference Faber MS, et al. Antibiotics for the common cold: expectations of Germany’s general population. Euro Surveill. 2010;15:35. Faber MS, et al. Antibiotics for the common cold: expectations of Germany’s general population. Euro Surveill. 2010;15:35.
37.
go back to reference Kochling A, et al. Reduction of antibiotic prescriptions for acute respiratory tract infections in primary care: a systematic review. Implement Sci. 2018;13(1):47.CrossRef Kochling A, et al. Reduction of antibiotic prescriptions for acute respiratory tract infections in primary care: a systematic review. Implement Sci. 2018;13(1):47.CrossRef
38.
go back to reference Irving G, et al. International variations in primary care physician consultation time: a systematic review of 67 countries. BMJ Open. 2017;7(10):e017902.CrossRef Irving G, et al. International variations in primary care physician consultation time: a systematic review of 67 countries. BMJ Open. 2017;7(10):e017902.CrossRef
39.
go back to reference Lee C, et al. The viral prescription pad - a mixed methods study to determine the need for and utility of an educational tool for antimicrobial stewardship in primary health care. BMC Fam Pract. 2020;21(1):42.CrossRef Lee C, et al. The viral prescription pad - a mixed methods study to determine the need for and utility of an educational tool for antimicrobial stewardship in primary health care. BMC Fam Pract. 2020;21(1):42.CrossRef
40.
go back to reference Lesnovska KP, et al. What do patients need to know? Living with inflammatory bowel disease. J Clin Nurs. 2014;23(11–12):1718–25.CrossRef Lesnovska KP, et al. What do patients need to know? Living with inflammatory bowel disease. J Clin Nurs. 2014;23(11–12):1718–25.CrossRef
41.
go back to reference Robinson A, et al. Guided self-management and patient-directed follow-up of ulcerative colitis: a randomised trial. Lancet. 2001;358(9286):976–81.CrossRef Robinson A, et al. Guided self-management and patient-directed follow-up of ulcerative colitis: a randomised trial. Lancet. 2001;358(9286):976–81.CrossRef
Metadata
Title
Evaluation of a multimodal intervention to promote rational antibiotic use in primary care
Authors
Inga Petruschke
Florian Salm
Michelle Kaufmann
Antje Freytag
Jochen Gensichen
Michael Behnke
Tobias Siegfried Kramer
Regina Hanke
Petra Gastmeier
Sandra Schneider
RAI Study Group
Publication date
01-12-2021
Publisher
BioMed Central
Keywords
Antibiotic
Care
Published in
Antimicrobial Resistance & Infection Control / Issue 1/2021
Electronic ISSN: 2047-2994
DOI
https://doi.org/10.1186/s13756-021-00908-9

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