scholarly journals Cost-effectiveness of internet-based training for primary care clinicians on antibiotic prescribing for acute respiratory tract infections in Europe

2018 ◽  
Vol 73 (11) ◽  
pp. 3189-3198 ◽  
Author(s):  
Raymond Oppong ◽  
Richard D Smith ◽  
Paul Little ◽  
Theo Verheij ◽  
Christopher C Butler ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Antibiotic Prescribing ◽  
Acute Respiratory Tract Infections ◽  
Primary Care Clinicians ◽  
Tract Infections

scholarly journals Antibiotic prescribing for acute respiratory tract infections in primary care: an updated and expanded meta-ethnography

2018 ◽  
Vol 68 (674) ◽  
pp. e633-e645 ◽  
Author(s):  
Evi Germeni ◽  
Julia Frost ◽  
Ruth Garside ◽  
Morwenna Rogers ◽  
Jose M Valderas ◽  
...  
Keyword(s):  
Primary Care ◽  
Respiratory Tract ◽  
Usual Care ◽  
Respiratory Tract Infections ◽  
Antibiotic Prescribing ◽  
Qualitative Synthesis ◽  
Acute Respiratory Tract Infections ◽  
Context Sensitive ◽  
Quality Improvement Interventions ◽  
Tract Infections

BackgroundReducing unnecessary prescribing remains a key priority for tackling the global rise of antibiotic-resistant infections.AimThe authors sought to update a 2011 qualitative synthesis of GPs’ experiences of antibiotic prescribing for acute respiratory tract infections (ARTIs), including their views of interventions aimed at more prudent prescribing. They expanded the original scope to encompass all primary care professionals (PCPs) who can prescribe or dispense antibiotics for ARTIs (for example, nurses and pharmacists).Design and settingSystematic review and meta-ethnography of qualitative studies.MethodA systematic search was conducted on MEDLINE, EMBASE, PsycINFO, CINAHL, ASSIA, and Web of Science. No date or language restrictions were used. Identified studies were grouped according to their thematic focus (usual care versus intervention), and two separate syntheses were performed.ResultsIn all, 53 articles reporting the experiences of >1200 PCPs were included. Analysis of usual-care studies showed that PCPs tend to assume multiple roles in the context of ARTI consultations (the expert self, the benevolent self, the practical self), depending on the range of intrapersonal, interpersonal, and contextual situations in which they find themselves. Analysis of intervention studies identified four possible ways in which PCPs may experience quality improvement interventions (compromise, ‘supportive aids’, source of distress, and unnecessary).ConclusionContrary to the original review, these results suggest that the use of the same intervention is experienced in a totally different way by different PCPs, and that the same elements that are perceived as benefits by some could be viewed as drawbacks by others. Acceptability of interventions is likely to increase if these are context sensitive and take into account PCPs’ varying roles and changing priorities.

scholarly journals Pediatrician Perceptions of an Outpatient Antimicrobial Stewardship Intervention

2014 ◽  
Vol 35 (S3) ◽  
pp. S69-S78 ◽  
Author(s):  
Julia E. Szymczak ◽  
Kristen A. Feemster ◽  
Theoklis E. Zaoutis ◽  
Jeffrey S. Gerber
Keyword(s):  
Primary Care ◽  
Respiratory Tract ◽  
Antimicrobial Stewardship ◽  
Respiratory Tract Infections ◽  
Audit And Feedback ◽  
Antibiotic Prescribing ◽  
Theory Approach ◽  
Antibiotic Overuse ◽  
Acute Respiratory Tract Infections ◽  
Tract Infections

Objective.Inappropriate antibiotic prescribing commonly occurs in pediatric outpatients with acute respiratory tract infections. Antimicrobial stewardship programs are recommended for use in the hospital, but less is known about whether and how they will work in the ambulatory setting. Following a successful cluster-randomized trial to improve prescribing for common acute respiratory tract infections using education plus audit and feedback in a large, pediatric primary care network, we sought to explore the perceptions of the intervention and antibiotic overuse among participating clinicians.Methods.We conducted a qualitative study using semistructured interviews with 24 pediatricians from 6 primary care practices who participated in an outpatient antimicrobial stewardship intervention. All interviews were transcribed and analyzed using a modified grounded theory approach.Results.Deep skepticism of the audit and feedback reports emerged. Respondents ignored reports or expressed distrust about them. One respondent admitted to gaming behavior. When asked about antibiotic overuse, respondents recognized it as a problem, but they believed it was driven by the behaviors of nonpediatric physicians. Parent pressure for antibiotics was identified by all respondents as a major barrier to the more judicious use of antibiotics. Respondents reported that they sometimes “caved” to parent pressure for social reasons.Conclusions.To improve the effectiveness and sustainability of outpatient antimicrobial stewardship, it is critical to boost the credibility of audit data, engage primary care pediatricians in recognizing that their behavior contributes to antibiotic overuse, and address parent pressure to prescribe antibiotics.

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