Implementation and outcomes of a 5-year intervention program to improve use of antibiotics in...
-
Upload
dina-arline-newton -
Category
Documents
-
view
215 -
download
0
Transcript of Implementation and outcomes of a 5-year intervention program to improve use of antibiotics in...
![Page 1: Implementation and outcomes of a 5-year intervention program to improve use of antibiotics in respiratory tract infection in primary care Judith Mackson.](https://reader033.fdocuments.in/reader033/viewer/2022051417/5697bfe21a28abf838cb4447/html5/thumbnails/1.jpg)
Implementation and outcomes of a 5-year intervention program to improve use of antibiotics
in respiratory tract infection in primary care
Judith Mackson
Education and QA Program Manager
L Weekes, C Bottomley, K Easton, L McMartin, M Fletcher, L Pont,
L Kenyon, S Wutzke, J Mandryk, C Babcock.
![Page 2: Implementation and outcomes of a 5-year intervention program to improve use of antibiotics in respiratory tract infection in primary care Judith Mackson.](https://reader033.fdocuments.in/reader033/viewer/2022051417/5697bfe21a28abf838cb4447/html5/thumbnails/2.jpg)
Primary care setting for intervention program
• Fee-for-service subsidised consultations• Subsidised antibiotic supply for low-income people• Unrestricted general practitioner (GP) prescribing
rights for oral antibiotics except for quinolones• Variable awareness of best-practice guidelines for
antibiotic prescribing• Rapidly changing cultural mix of patients and GPs in
urban areas• Highly regulated pharmacy services
![Page 3: Implementation and outcomes of a 5-year intervention program to improve use of antibiotics in respiratory tract infection in primary care Judith Mackson.](https://reader033.fdocuments.in/reader033/viewer/2022051417/5697bfe21a28abf838cb4447/html5/thumbnails/3.jpg)
Need to understand influences on antibiotic prescribing in primary care
Complex biomedical and social factors including:Patient
– Desire for tangible outcome of consultation– Perceptions of effectiveness esp. in viral illness
Doctor– Information gap regarding best-practice prescribing– Desire to satisfy patient demand– Consultation process: short, fee-for-service– Marketing especially newer antibiotics
![Page 4: Implementation and outcomes of a 5-year intervention program to improve use of antibiotics in respiratory tract infection in primary care Judith Mackson.](https://reader033.fdocuments.in/reader033/viewer/2022051417/5697bfe21a28abf838cb4447/html5/thumbnails/4.jpg)
Key messages to address influencing factors
For health professionals– limited indications in URTI
• no role in viral illness• limited role in sore throat, otitis media, sinusitis: use only if
benefit can be expected
– appropriate selection• use narrow spectrum• amoxycillin drug of choice for most URTIs
– review your prescribing– discuss realistic expectations with patients
For consumers– You won’t get better more quickly by taking antibiotics for a
common cold
![Page 5: Implementation and outcomes of a 5-year intervention program to improve use of antibiotics in respiratory tract infection in primary care Judith Mackson.](https://reader033.fdocuments.in/reader033/viewer/2022051417/5697bfe21a28abf838cb4447/html5/thumbnails/5.jpg)
Program objectives
• To decrease volume of antibiotic prescriptions by GPs for upper respiratory tract infections (URTI) and acute bronchitis– Low rates for acute bronchitis, pharyngitis, lower rates acute
otitis media (AOM), acute sinusitis • To increase proportion of first-line antibiotic selection when an
antibiotic required (appropriate and minimises selection pressure)– Amoxycillin first-line AOM, acute sinusitis, penicillin V first line
strep throat and tonsillitis• To encourage a more judicious approach to antibiotic prescribing
for URTI and bronchitis• To inform consumers of limited benefit of antibiotics in URTI and to
encourage symptom management
![Page 6: Implementation and outcomes of a 5-year intervention program to improve use of antibiotics in respiratory tract infection in primary care Judith Mackson.](https://reader033.fdocuments.in/reader033/viewer/2022051417/5697bfe21a28abf838cb4447/html5/thumbnails/6.jpg)
Multifaceted interventions
For health professionals• Written materials and GP prescription
feedback annually for 5 years, voluntary educational & quality assurance activities for GPs, patient education leaflets
For consumers• Media advertising, ‘grass roots’
meetings over 3-4 years
![Page 7: Implementation and outcomes of a 5-year intervention program to improve use of antibiotics in respiratory tract infection in primary care Judith Mackson.](https://reader033.fdocuments.in/reader033/viewer/2022051417/5697bfe21a28abf838cb4447/html5/thumbnails/7.jpg)
1999 2000 2001 2002 2003
Time-line of interventions
Academic detailing
Mailed GP prescription feedback
Clinical audit
Newsletter
Consumer campaign
Case study
![Page 8: Implementation and outcomes of a 5-year intervention program to improve use of antibiotics in respiratory tract infection in primary care Judith Mackson.](https://reader033.fdocuments.in/reader033/viewer/2022051417/5697bfe21a28abf838cb4447/html5/thumbnails/8.jpg)
Evaluation of program
• Process including participation rates• Awareness, knowledge and attitudes GP,
pharmacist and consumer• GP use of antibiotic guidelines• Antibiotic utilisation, prescribing rates
– Total volume, GP prescribing URTI, first-line selection, undesirable switching
![Page 9: Implementation and outcomes of a 5-year intervention program to improve use of antibiotics in respiratory tract infection in primary care Judith Mackson.](https://reader033.fdocuments.in/reader033/viewer/2022051417/5697bfe21a28abf838cb4447/html5/thumbnails/9.jpg)
Community use of antibiotics (DDD/1000/day) – continued decline
National antibiotic utilisation
0
5
10
15
20
25
30
1995 1996 1997 1998 1999 2000 2001 2002 2003
Year
DDD/
1000
pop
ulat
ion/
day
All antibiotics (ATC J01 -oral + parenteral)
AMOXYCILLIN
AMOXYCILLIN w ith CLAVULANIC AC
CEFACLOR
CEFUROXIME
CLARITHROMYCIN
DOXYCYCLINE
ERYTHROMYCIN
PENICILLIN V
ROXITHROMYCIN
CEPHALEXIN
Source: DUSC data
![Page 10: Implementation and outcomes of a 5-year intervention program to improve use of antibiotics in respiratory tract infection in primary care Judith Mackson.](https://reader033.fdocuments.in/reader033/viewer/2022051417/5697bfe21a28abf838cb4447/html5/thumbnails/10.jpg)
GP prescriptions antibiotics primarily used URTI –continued decline, reduced peaks
![Page 11: Implementation and outcomes of a 5-year intervention program to improve use of antibiotics in respiratory tract infection in primary care Judith Mackson.](https://reader033.fdocuments.in/reader033/viewer/2022051417/5697bfe21a28abf838cb4447/html5/thumbnails/11.jpg)
GP prescribing rate all URTI problems- significant decrease over 4 years
Percentage of URTI problems where an antibiotic was prescribed-BEACH data (URTI=our defintion)
43
44
45
46
47
48
49
50
51
52
1999 2000 2001 2002
year
per
cen
tag
e o
f U
RT
I pro
ble
ms
n URTI
encoutners=12 809
n URTI
encoutners=10 900
n URTI
encoutners=10 004
n URTI
encoutners=11 046
BEACH data
50.4%
46.9%
![Page 12: Implementation and outcomes of a 5-year intervention program to improve use of antibiotics in respiratory tract infection in primary care Judith Mackson.](https://reader033.fdocuments.in/reader033/viewer/2022051417/5697bfe21a28abf838cb4447/html5/thumbnails/12.jpg)
Conclusions
• Sustained decrease total use antibiotics• Sustained decrease GP prescribing• Decreased GP prescribing rate for URTI• Change in mix of drugs toward recommended
first-line agents• Fewer consumers believed antibiotics were
appropriate for treating colds or ‘flu
![Page 13: Implementation and outcomes of a 5-year intervention program to improve use of antibiotics in respiratory tract infection in primary care Judith Mackson.](https://reader033.fdocuments.in/reader033/viewer/2022051417/5697bfe21a28abf838cb4447/html5/thumbnails/13.jpg)
Key lessons from this program
• Develop good processes to understand the determinants that lead to inappropriate antibiotic use locally– eg concern regarding S. pneumoniae resistance reduced
prescriber confidence in amoxycillin for all indications
• Planning may have unexpected findings. ..– Common colds needs common sense message developed
not because of high rate of prescribing in common cold, but a complex of symptoms which consumers understood
– Prescribers not motivated by global antibiotic burden and confusion regarding antimicrobial resistance among prescribers and consumers means not a useful message
![Page 14: Implementation and outcomes of a 5-year intervention program to improve use of antibiotics in respiratory tract infection in primary care Judith Mackson.](https://reader033.fdocuments.in/reader033/viewer/2022051417/5697bfe21a28abf838cb4447/html5/thumbnails/14.jpg)
Key lessons continued
• Long–term programs are required to allow for repetition and refinement of program messages
• Different interventions may be required to change total prescribing rate verus change in antibiotic selection
• Some prescribing more difficult to change– Acute bronchitis – due to severity of symptoms,
diagnostic uncertainty?– Roxithromycin – heavily marketed, once daily
dosing, few adverse effects
![Page 15: Implementation and outcomes of a 5-year intervention program to improve use of antibiotics in respiratory tract infection in primary care Judith Mackson.](https://reader033.fdocuments.in/reader033/viewer/2022051417/5697bfe21a28abf838cb4447/html5/thumbnails/15.jpg)
Key lessons cont’d
• A consumer campaign may be a key component to reduce patient demand and GP perceptions of demand and therefore total volume
• Can effectively use media to disseminate messages to the community especially via local radio
• More possibility of change in antibiotic use than other drug classes
• Financial and professional incentives for GPs important for voluntary participation
![Page 16: Implementation and outcomes of a 5-year intervention program to improve use of antibiotics in respiratory tract infection in primary care Judith Mackson.](https://reader033.fdocuments.in/reader033/viewer/2022051417/5697bfe21a28abf838cb4447/html5/thumbnails/16.jpg)
Implications for policies and programs
• Long term programs allowing repetition• National versus regional programs: design
messages and interventions tailored to the prescribers and consumers where influences on drug use can be understood
• Expertise in social marketing for consumer campaigns, need to target audiences for best use of funds
![Page 17: Implementation and outcomes of a 5-year intervention program to improve use of antibiotics in respiratory tract infection in primary care Judith Mackson.](https://reader033.fdocuments.in/reader033/viewer/2022051417/5697bfe21a28abf838cb4447/html5/thumbnails/17.jpg)
Research questions
• Can models be developed to engage pharmaceutical industry in appropriate marketing?
• What is the optimally low level of antibiotic prescribing?
• What indicators are needed to ensure no unintended effects?
• What is the optimal mix of interventions for what time period? Where has change not occurred?
• Has this program resulted in reduced rate of development of antimicrobial resistance?