Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Primary Care
Published in: BMC Primary Care 1/2010

Open Access 01-12-2010 | Research article

Enhancing the quality of antibiotic prescribing in Primary Care: Qualitative evaluation of a blended learning intervention

Authors: Marie-Jet Bekkers, Sharon A Simpson, Frank Dunstan, Kerry Hood, Monika Hare, John Evans, Christopher C Butler, the STAR study team

Published in: BMC Primary Care | Issue 1/2010

Login to get access

Abstract

Background

The Stemming the Tide of Antibiotic Resistance (STAR) Educational Program aims to enhance the quality of antibiotic prescribing and raise awareness about antibiotic resistance among general medical practitioners. It consists of a seven part, theory-based blended learning program that includes online reflection on clinicians' own practice, presentation of research evidence and guidelines, a practice-based seminar focusing on participants' own antibiotic prescribing and resistance rates in urine samples sent from their practice, communication skills training using videos of simulated patients in routine surgeries, and participation in a web forum. Effectiveness was evaluated in a randomised controlled trial in which 244 GPs and Nurse Practitioners and 68 general practices participated. This paper reports part of the process evaluation of that trial.

Methods

Semi-structured, digitally recorded, and transcribed telephone interviews with 31 purposively sampled trial participants analysed using thematic content analysis.

Results

The majority of participants reported increased awareness of antibiotic resistance, greater self-confidence in reducing antibiotic prescribing and at least some change in consultation style and antibiotic prescribing behaviour. Reported practical changes included adopting a practice-wide policy of antibiotic prescription reduction. Many GPs also reported increased insight into patients' expectations, ultimately contributing to improved doctor-patient rapport. The components of the intervention put forward as having the greatest influence on changing clinician behaviour were the up-to-date research evidence resources, simple and effective communication skills presented in on-line videos, and presentation of the practice's own antibiotic prescribing levels combined with an overview of local resistance data.

Conclusion

Participants regarded this complex blended learning intervention acceptable and feasible, and reported wide-ranging, positive changes in attitudes and clinical practice as a result of participating in the STAR Educational Program.

Trial registration

Current Controlled Trials ISRCTN63355948
Appendix
Available only for authorised users
Literature
1.
Wise R, Hart T, Cars O, Streulens M, Helmuth R, Huovinen P, Sprenger M: Antimicrobial resistance is a major threat to public health. BMJ. 1998, 317: 609-610.CrossRefPubMedPubMedCentral
2.
3.
Cosby JL, Francis N, Butler CC: The role of evidence in the decline of antibiotic use for common respiratory infections in primary care. Lancet Infect Dis. 2007, 7 (11): 749-756. 10.1016/S1473-3099(07)70263-3.CrossRefPubMed
4.
Michael J, Pucci TJD, Barrett John: Why are there no new antibiotics?. Expert Opinion on Investigational Drugs. 1998, 7 (8): 1233-1235. 10.1517/13543784.7.8.1233.CrossRef
5.
Cars O, Molstad S, Melander A: Variation in antibiotic use in the European Union. Lancet. 2001, 357 (9271): 1851-1853. 10.1016/S0140-6736(00)04972-2.CrossRefPubMed
6.
Seppala H, Klaukka T, Vuopio-Varkila J, Muotiala A, Helenius H, Lager K, Huovinen P: The effect of changes in the consumption of macrolide antibiotics on erythromycin resistance in group A streptococci in Finland. Finnish Study Group for Antimicrobial Resistance. N Engl J Med. 1997, 337 (7): 441-446. 10.1056/NEJM199708143370701.CrossRefPubMed
7.
Simpson SA, Wood F, Butler CC: General practitioners' perceptions of antimicrobial resistance: a qualitative study. J Antimicrob Chemother. 2007, 59 (2): 292-296. 10.1093/jac/dkl467.CrossRefPubMed
8.
Butler CC, Rollnick S, Maggs-Rapport F, Pill RM, Stott NCH: Understanding the culture of prescribing: A qualitative study of general practitioners' and patients' perceptions of antibiotics for sore throats. BMJ. 1998, 317: 637-642.CrossRefPubMedPubMedCentral
9.
Coenen SMB, Renard D, Denekens J, Van Royen P: Antibiotic prescribing for acute cough: the effect of perceived patient demand. Br J GenPract. 2006, Mar; 56 (524): 183-190.
10.
Cals JWBC, Hopstaken RM, Hood K, Dinant GJ: Effect of point of care testing for C reactive protein and training in communication skills on antibiotic use in lower respiratory tract infections: cluster randomised trial. BMJ. 2009, May 5 (338):
11.
Simpson S, Butler C, Hood K, Cohen D, Dunstan F, Evans M, Rollnick S, Moore L, Hare M, Bekkers M, the STAR study team: Stemming the Tide of Antibiotic Resistance (STAR): a protocol for a trial of a complex intervention addressing the 'why' and 'how' of appropriate antibiotic prescribing in general practice. BMC Fam Pract. 2009, 10: 20-10.1186/1471-2296-10-20.CrossRefPubMedPubMedCentral
12.
Eccles M, Grimshaw J, Walker A, Johnston M, Pitts N: Changing the behavior of healthcare professionals: the use of theory in promoting the uptake of research findings. J Clin Epidemiol. 2005, 58 (2): 107-112. 10.1016/j.jclinepi.2004.09.002.CrossRefPubMed
13.
Simpson SARS, Spanou C, Hood K, Dougall V, Butler CC: An evidence, theory and experienced-based framework for developing blended learning programs for continuing medical education.
14.
Ajzen I: Perceived behavioural control, self efficacy, locus of control and the theory of planned behaviour. J Appl Psychol. 2002, 32: 1-20. 10.1111/j.1559-1816.2002.tb01418.x.
15.
Hardeman W, Johnston M, Johnston D, Bonetti D, Wareham N, Kinmonth A: Application of the theory of planned behaviour in behaviour change interventions: a systematic review. Psychol Health. 2002, 17 (2): 123-158.CrossRef
16.
Bandura A: Social Foundations of Thought and Action: A Social Cognitive Theory. 1986, New Jersey: Prentice Hall, Eaglewood Cliffs
17.
Bandura A: Health promotion from the perspective of social cognitive theory. Psychol Health. 1998, 13 (4): 623-649. 10.1080/08870449808407422.CrossRef
18.
Butler CC, Rollnick S, Kinnersley P, Jones A, Stott NCH: Reducing antibiotics for respiratory tract symptoms in primary care; consolidating 'why' and considering 'how'. Br J Gen Pract. 1998, 48: 1865-1870.PubMedPubMedCentral
19.
Armitage CJ, Conner M: Efficacy of the Theory of Planned Behaviour: a meta-analytic review. Br J Soc Psychol. 2001, 40 (Pt 4): 471-499. 10.1348/014466601164939.CrossRefPubMed
20.
Rollnick S, Kinnersley P, Butler C: Context-bound communication skills training: development of a new method. Med Educ. 2002, 36 (4): 377-383. 10.1046/j.1365-2923.2002.01174.x.CrossRefPubMed
21.
Geraets JGM, Goossens M, van Haastregt J, de Groot I, de Bruijn C, de Bie R, Köke A, Heuvel van den W: Implications of process evaluation for clinical effectiveness and clinical practice in a trial on chronic shoulder complaints. Patient Education and Counseling. 2006, 61 (1): 117-125. 10.1016/j.pec.2005.02.017.CrossRefPubMed
22.
Welschen I, Kuyvenhoven M, Hoes A, TJ V: Effectiveness of a multiple intervention to reduce antibiotic prescribing for respiratory tract symptoms in primary care: randomised controlled trial. BMJ. 2004, 329 (431):
23.
Smeets H, Kuyvenhoven M, Akkerman A, Welschen I, Schouten G, van Essen G, Verheij T: Intervention with educational outreach at large scale to reduce antibiotics for respiratory tract infections: a controlled before and after study. Fam Pract. 2009, 3:
24.
Altiner A, Brockmann S, Sielk M, Wilm S, Wegscheider K, Abholz H: 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): 638-644. 10.1093/jac/dkm254.CrossRefPubMed
25.
Hamm RM, Hicks RJ, Bemben DA: Antibiotics and respiratory infections: Are patients more satisfied when expectations are met?. J Fam Pract. 1996, 43: 56-62.PubMed
26.
Welschen I: Prescribing antibiotics for acute respiratory tract infections in primary care: improving doctors' prescribing and exploring patients' satisfaction. 2004, University of Utrecht, General Practice
27.
Belfield C, Brown C, Thomas H, Field S, Cooper R: Cost-effective continuing professional development in the NHS. 2001, London: Department of Health
28.
Goodyear-Smith F, Whitehorn M, McCormick R: Experiences and preferences of general practitioners regarding continuing medical education: a qualitative study. N Z Med J. 2003, 116 (1172): 399-
29.
The Standing Committee on Postgraduate Medicine and Dental Education (SCOPME): The educational needs of GP non-principals. 1998, London: Royal College of General Practitioners
30.
Davis D, Thomson M, Oxman A, Haynes R: Changing physician performance. A systematic review of the effect of continuing medical education strategies. JAMA. 1995, 274 (9): 700-705. 10.1001/jama.274.9.700.CrossRefPubMed
31.
Sancho P, Corral R, Rivas T, González M, Chordi A, Tejedor C: A blended learning experience for teaching microbiology. Am J Pharm Educ. 2006, 70 (5): 120-CrossRefPubMedPubMedCentral
32.
Dean P, Stahl M, Sylwester D, Pear J: Effectiveness of Combined Delivery Modalities for Distance Learning and Resident Learning. Quart Rev Dist Educ. 2001, 2 (3): 247-254.
33.
Rieger U, Pierer K, Farhadi J, Lehmann T, Röers B, Pierer G: Effective acquisition of basic surgical techniques through Blended Learning. Chirurg. 2008, Nov 13:
34.
Cook D: Where are we with Web-based learning in medical education?. Med Teach. 2006, 28 (7): 594-598. 10.1080/01421590601028854.CrossRefPubMed
35.
Chumley-Jones H, Dobbie A, Alford C: Web-based learning: sound educational method or hype? A review of the evaluation literature. Acad Med. 2002, 77 (10 suppl): S86-93.CrossRefPubMed
Metadata
Title
Enhancing the quality of antibiotic prescribing in Primary Care: Qualitative evaluation of a blended learning intervention
Authors
Marie-Jet Bekkers
Sharon A Simpson
Frank Dunstan
Kerry Hood
Monika Hare
John Evans
Christopher C Butler
the STAR study team
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2010
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/1471-2296-11-34

Other articles of this Issue 1/2010

BMC Primary Care 1/2010 Go to the issue

Research article

An exploration of lifestyle beliefs and lifestyle behaviour following stroke: findings from a focus group study of patients and family members

Debate

Palliative care in urgent need of recognition and development in general practice: the example of Germany

Research article

Primary care physicians' use of family history for cancer risk assessment

Research article

Low hospital admission rates for respiratory diseases in children

Research article

Medically unexplained pain complaints are associated with underlying unrecognized mood disorders in primary care

Research article

Randomised controlled trial of local corticosteroid injections for carpal tunnel syndrome in general practice