Shared decision support for patients. An antimicrobial stewardship strategy to promote appropriate antibiotics use in primary care
Project Details
This project pilots a suite of shared decision support tools that provide information and support clinical discussion and decision making with patients with common infections in primary care: respiratory tract infections (RTIs), skin and soft and tissue infections (SSTIs) and urinary tract infections (UTIs). Its assesses whether these tools will be acceptable for general practitioners (GPs) and patients to reduce inappropriate antibiotic prescribing for common infections with the aim to reduce inappropriate antibiotic prescribing.
Grant number: ECR0762020 | Funding period 2020- 2021
Patron ID: PAT014
Project Lead:
The aim of this project was to pilot a suite of shared decision support tools to provide information and support clinical discussion and decision making with patients with common infections in primary care. These decision support tools will consist information for patients with regards to common symptoms, natural history of illness, and useful management strategies for respiratory tract infections (RTIs), soft skin and tissue infections (SSTIs) and urinary tract infections (UTIs). We aimed to assess whether these tools will be acceptable for general practitioners (GPs) and patients to reduce inappropriate antibiotic prescribing for common infections.
We aimed to recruit 10 Patron general practices across Victoria to pilot these tools. During the 5-month intervention period (June to October), participating GPs accessed these tools with patients coming in for a RTI, SSTI or UTI consult to discuss management and treatment options that may or may not benefit with antibiotic use. De-identified information about RTI, SSTI, and UTI consultations and antibiotics prescribed before and after the intervention period were obtained to assess the effectiveness of these tools in reducing the number of antibiotics prescribed. Semi-structured interviews with GPs and patients around acceptability and usability of the tools were conducted.
Research Outcomes
Results
From 13 641 recorded prescriptions, 178 were recorded for dental presentations, representing 1.3% of all antibiotic prescriptions. When assessed against the guidelines, 23.6% (n = 42) were considered appropriate. The top 3 most commonly prescribed antibiotics were amoxicillin (n = 84, 47.2%), amoxicillin/clavulanic acid (n = 52, 29.2%) and metronidazole (n = 15, 8.4%). The reasons for inappropriate prescribing were as follows: third-line treatment being chosen, inappropriate spectrum, incorrect regimen or prescribing an antibiotic not recommended in the guidelines.
Conclusion
These results indicate a need to better understand the potential patient drivers for antibiotic prescription for GPs and patients, and resources GPs need to manage dental presentations. These results will inform the co-design of targeted interventions to address any educational gaps and barriers to accessing dental treatment and thus improving antibiotic prescribing.
- The results of the study were presented at the AAAPC conference in 2021 and SAPC conference in 2022.
Research Publications
- Teoh L, Hopcraft M, McCullough M, Manski-Nankervis J-A, Biezen R. Exploring the appropriateness of antibiotic prescribing for dental presentations in Australian general practice—A pilot study. Br J Clin Pharmacol. 2023; 89(5): 1554-1559. doi:10.1111/bcp.15617