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Antibiotic prescribing in UK out-of-hours primary care services: a realist-informed scoping review of training and guidelines for healthcare professionals

Antibiotic prescribing in UK out-of-hours primary care services: a realist-informed scoping review of training and guidelines for healthcare professionals
Antibiotic prescribing in UK out-of-hours primary care services: a realist-informed scoping review of training and guidelines for healthcare professionals
Background: Antibiotic overuse has contributed to antimicrobial resistance, which is a global public health problem. In the UK, despite the fall in rates of antibiotic prescription since 2013, prescribing levels remain high in comparison with other European countries. Prescribing in out-of-hours (OOH) care provides unique challenges for prudent prescribing, for which professionals may not be prepared. Aim: To explore the guidance available to professionals on prescribing antibiotics for common infections in OOH primary care within the UK, with a focus on training resources, guidelines, and clinical recommendations. Design & setting: A realist-informed scoping review of peer-reviewed articles and grey literature. Method: The review focused on antibiotic prescribing OOH (for example, clinical guidelines and training videos). General prescribing guidance was searched whenever OOH-focused resources were unavailable. Electronic databases and websites of national agencies and professional societies were searched following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Findings were organised according to realist review components, that is, mechanisms, contexts, and outcomes. Results: In total, 46 clinical guidelines and eight training resources were identified. Clinical guidelines targeted adults and children, and included recommendations on prescription strategy, spectrum of the antibiotic prescribed, communication with patients, treatment duration, and decision-making processes. No clinical guidelines or training resources focusing specifically on OOH were found. Conclusion: The results highlight a lack of knowledge about whether existing resources address the challenges faced by OOH antibiotic prescribers. Further research is needed to explore the training needs of OOH health professionals, and whether further OOH-focused resources need to be developed given the rates of antibiotic prescribing in this setting.
after-hours care, anti-bacterial agents, bacterial, community care, drug resistance, guidelines, prescribing
1-9
Alves, Paula Gomes
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Hayward, Gail
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Leydon, Geraldine
c5cdaff5-0fa1-4d38-b575-b97c2892ec40
Barnes, Rebecca
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Woods, Catherine
239255f5-6dfe-43c4-9650-56ee03f2b06c
Webb, Joseph
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Booker, Matthew
fd92070d-ef4e-4e1c-9dea-26041ba1b77b
Ireton, Helen
44ca5108-cb9e-4cb7-b7ca-90f83690c8de
Latter, Sue
83f100a4-95ec-4f2e-99a5-186095de2f3b
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Moore, Michael
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Nicholls, Clare-louise
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Stevenson, Fiona
881eb2a9-d7a8-449d-be50-ead6fda5cd3e
Alves, Paula Gomes
e26a92de-88d6-44ca-95b2-e82cc7977839
Hayward, Gail
91362d6f-3c3b-4eae-8fc8-1571ccf184c1
Leydon, Geraldine
c5cdaff5-0fa1-4d38-b575-b97c2892ec40
Barnes, Rebecca
5f2ab8e7-129c-4ca2-8022-dc371e740597
Woods, Catherine
239255f5-6dfe-43c4-9650-56ee03f2b06c
Webb, Joseph
6cf2eea7-81d3-437f-a492-e05e685ebf5a
Booker, Matthew
fd92070d-ef4e-4e1c-9dea-26041ba1b77b
Ireton, Helen
44ca5108-cb9e-4cb7-b7ca-90f83690c8de
Latter, Sue
83f100a4-95ec-4f2e-99a5-186095de2f3b
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Nicholls, Clare-louise
00482249-fb62-4906-bbac-6565f5c19221
Stevenson, Fiona
881eb2a9-d7a8-449d-be50-ead6fda5cd3e

Alves, Paula Gomes, Hayward, Gail, Leydon, Geraldine, Barnes, Rebecca, Woods, Catherine, Webb, Joseph, Booker, Matthew, Ireton, Helen, Latter, Sue, Little, Paul, Moore, Michael, Nicholls, Clare-louise and Stevenson, Fiona (2021) Antibiotic prescribing in UK out-of-hours primary care services: a realist-informed scoping review of training and guidelines for healthcare professionals. BJGP Open, 5 (3), 1-9, [BJGPO.2020.0167]. (doi:10.3399/BJGPO.2020.0167).

Record type: Article

Abstract

Background: Antibiotic overuse has contributed to antimicrobial resistance, which is a global public health problem. In the UK, despite the fall in rates of antibiotic prescription since 2013, prescribing levels remain high in comparison with other European countries. Prescribing in out-of-hours (OOH) care provides unique challenges for prudent prescribing, for which professionals may not be prepared. Aim: To explore the guidance available to professionals on prescribing antibiotics for common infections in OOH primary care within the UK, with a focus on training resources, guidelines, and clinical recommendations. Design & setting: A realist-informed scoping review of peer-reviewed articles and grey literature. Method: The review focused on antibiotic prescribing OOH (for example, clinical guidelines and training videos). General prescribing guidance was searched whenever OOH-focused resources were unavailable. Electronic databases and websites of national agencies and professional societies were searched following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Findings were organised according to realist review components, that is, mechanisms, contexts, and outcomes. Results: In total, 46 clinical guidelines and eight training resources were identified. Clinical guidelines targeted adults and children, and included recommendations on prescription strategy, spectrum of the antibiotic prescribed, communication with patients, treatment duration, and decision-making processes. No clinical guidelines or training resources focusing specifically on OOH were found. Conclusion: The results highlight a lack of knowledge about whether existing resources address the challenges faced by OOH antibiotic prescribers. Further research is needed to explore the training needs of OOH health professionals, and whether further OOH-focused resources need to be developed given the rates of antibiotic prescribing in this setting.

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More information

Accepted/In Press date: 8 March 2020
Published date: 27 April 2021
Keywords: after-hours care, anti-bacterial agents, bacterial, community care, drug resistance, guidelines, prescribing

Identifiers

Local EPrints ID: 448846
URI: http://eprints.soton.ac.uk/id/eprint/448846
PURE UUID: fc63d687-d494-441f-ac3d-f90f403182da
ORCID for Geraldine Leydon: ORCID iD orcid.org/0000-0001-5986-3300
ORCID for Sue Latter: ORCID iD orcid.org/0000-0003-0973-0512
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509

Catalogue record

Date deposited: 06 May 2021 16:33
Last modified: 10 Jan 2022 02:50

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Contributors

Author: Paula Gomes Alves
Author: Gail Hayward
Author: Rebecca Barnes
Author: Catherine Woods
Author: Joseph Webb
Author: Matthew Booker
Author: Helen Ireton
Author: Sue Latter ORCID iD
Author: Paul Little
Author: Michael Moore ORCID iD
Author: Clare-louise Nicholls
Author: Fiona Stevenson

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