The University of Southampton
University of Southampton Institutional Repository
Warning ePrints Soton is experiencing an issue with some file downloads not being available. We are working hard to fix this. Please bear with us.

Implementing interventions to reduce antibiotic use: a qualitative study in high-prescribing practices

Implementing interventions to reduce antibiotic use: a qualitative study in high-prescribing practices
Implementing interventions to reduce antibiotic use: a qualitative study in high-prescribing practices
Background: Trials have shown that delayed antibiotic prescriptions (DPs) and point-of-care C-Reactive Protein testing (POC-CRPT) are effective in reducing antibiotic use in general practice, but these were not typically implemented in high-prescribing practices. We aimed to explore views of professionals from high-prescribing practices about uptake and implementation of DPs and POC-CRPT to reduce antibiotic use.
Methods: This was a qualitative focus group study in English general practices. The highest antibiotic prescribing practices in the West Midlands were invited to participate. Clinical and non-clinical professionals attended focus groups co-facilitated by two researchers. Focus groups were audio-recorded, transcribed verbatim and analysed thematically.
Results: Nine practices (50 professionals) participated. Four main themes were identified. Compatibility of strategies with clinical roles and experience – participants viewed the strategies as having limited value as ‘clinical tools’, perceiving them as useful only in ‘rare’ instances of clinical uncertainty and/or for those less experienced. Strategies as ‘social tools’ – participants perceived the strategies as helpful for negotiating treatment decisions and educating patients, particularly those expecting antibiotics. Ambiguities – participants perceived ambiguities around when they should be used, and about their impact on antibiotic use. Influence of context – various other situational and practical issues were raised with implementing the strategies.
Conclusions: High-prescribing practices do not view DPs and POC-CRPT as sufficiently useful ‘clinical tools’ in a way which corresponds to the current policy approach advocating their use to reduce clinical uncertainty and improve antimicrobial stewardship. Instead, policy attention should focus on how these strategies may instead be used as ‘social tools’ to reduce unnecessary antibiotic use. Attentions should also focus on the many ambiguities (concerns and questions) about, and contextual barriers to, using these strategies need addressing to support wider and more consistent implementation.
Antibiotic resistance, Antibiotics, Antimicrobial stewardship, Back-up prescription, Focus groups, General practice, Point-of-care testing
1471-2296
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Borek, Aleksandra
bd62f409-7016-4978-87ed-e35e6299967c
Campbell, Anne
d85ff9e9-d537-4c4f-910f-9ec35d6f462e
Butler, Christopher C.
c8cc70b1-5fb9-4b03-bb80-11c6aabb7e6f
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Borek, Aleksandra
bd62f409-7016-4978-87ed-e35e6299967c
Campbell, Anne
d85ff9e9-d537-4c4f-910f-9ec35d6f462e
Butler, Christopher C.
c8cc70b1-5fb9-4b03-bb80-11c6aabb7e6f

Moore, Michael, Borek, Aleksandra, Campbell, Anne and Butler, Christopher C. (2021) Implementing interventions to reduce antibiotic use: a qualitative study in high-prescribing practices. BMC Family Practice, 22 (1), [25]. (doi:10.1186/s12875-021-01371-6).

Record type: Article

Abstract

Background: Trials have shown that delayed antibiotic prescriptions (DPs) and point-of-care C-Reactive Protein testing (POC-CRPT) are effective in reducing antibiotic use in general practice, but these were not typically implemented in high-prescribing practices. We aimed to explore views of professionals from high-prescribing practices about uptake and implementation of DPs and POC-CRPT to reduce antibiotic use.
Methods: This was a qualitative focus group study in English general practices. The highest antibiotic prescribing practices in the West Midlands were invited to participate. Clinical and non-clinical professionals attended focus groups co-facilitated by two researchers. Focus groups were audio-recorded, transcribed verbatim and analysed thematically.
Results: Nine practices (50 professionals) participated. Four main themes were identified. Compatibility of strategies with clinical roles and experience – participants viewed the strategies as having limited value as ‘clinical tools’, perceiving them as useful only in ‘rare’ instances of clinical uncertainty and/or for those less experienced. Strategies as ‘social tools’ – participants perceived the strategies as helpful for negotiating treatment decisions and educating patients, particularly those expecting antibiotics. Ambiguities – participants perceived ambiguities around when they should be used, and about their impact on antibiotic use. Influence of context – various other situational and practical issues were raised with implementing the strategies.
Conclusions: High-prescribing practices do not view DPs and POC-CRPT as sufficiently useful ‘clinical tools’ in a way which corresponds to the current policy approach advocating their use to reduce clinical uncertainty and improve antimicrobial stewardship. Instead, policy attention should focus on how these strategies may instead be used as ‘social tools’ to reduce unnecessary antibiotic use. Attentions should also focus on the many ambiguities (concerns and questions) about, and contextual barriers to, using these strategies need addressing to support wider and more consistent implementation.

Text
Borek, Campbell et al_BMC Fam Pract_Accepted Manuscript - Accepted Manuscript
Available under License Creative Commons Attribution.
Download (150kB)

More information

Accepted/In Press date: 9 January 2021
e-pub ahead of print date: 23 January 2021
Keywords: Antibiotic resistance, Antibiotics, Antimicrobial stewardship, Back-up prescription, Focus groups, General practice, Point-of-care testing

Identifiers

Local EPrints ID: 446707
URI: http://eprints.soton.ac.uk/id/eprint/446707
ISSN: 1471-2296
PURE UUID: 2a091d30-7778-4c46-816b-1c79966bf698
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509

Catalogue record

Date deposited: 18 Feb 2021 17:31
Last modified: 10 Jan 2022 02:49

Export record

Altmetrics

Contributors

Author: Michael Moore ORCID iD
Author: Aleksandra Borek
Author: Anne Campbell
Author: Christopher C. Butler

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×