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Best practice guidance for antibiotic audit and feedback interventions in primary care: a modified Delphi study from the Joint Programming Initiative on Antimicrobial resistance: Primary Care Antibiotic Audit and Feedback Network (JPIAMR-PAAN)

Best practice guidance for antibiotic audit and feedback interventions in primary care: a modified Delphi study from the Joint Programming Initiative on Antimicrobial resistance: Primary Care Antibiotic Audit and Feedback Network (JPIAMR-PAAN)
Best practice guidance for antibiotic audit and feedback interventions in primary care: a modified Delphi study from the Joint Programming Initiative on Antimicrobial resistance: Primary Care Antibiotic Audit and Feedback Network (JPIAMR-PAAN)

Background: primary care is a critical partner for antimicrobial stewardship efforts given its high human antibiotic usage. Peer comparison audit and feedback (A&F) is often used to reduce inappropriate antibiotic prescribing. The design and implementation of A&F may impact its effectiveness. There are no best practice guidelines for peer comparison A&F in antibiotic prescribing in primary care. 

Objective: to develop best practice guidelines for peer comparison A&F for antibiotic prescribing in primary care in high income countries by leveraging international expertise via the Joint Programming Initiative on Antimicrobial Resistance-Primary Care Antibiotic Audit and Feedback Network. 

Methods: we used a modified Delphi process to achieve convergence of expert opinions on best practice statements for peer comparison A&F based on existing evidence and theory. Three rounds were performed, each with online surveys and virtual meetings to enable discussion and rating of each best practice statement. A five-point Likert scale was used to rate consensus with a median threshold score of 4 to indicate a consensus statement. 

Results: the final set of guidelines include 13 best practice statements in four categories: general considerations (n = 3), selecting feedback recipients (n = 1), data and indicator selection (n = 4), and feedback delivery (n = 5). CONCLUSION: We report an expert-derived best practice recommendations for designing and evaluating peer comparison A&F for antibiotic prescribing in primary care. These 13 statements can be used by A&F designers to optimize the impact of their quality improvement interventions, and improve antibiotic prescribing in primary care.

Schwartz, Kevin L.
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Xu, Alice X.T.
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Alderson, Sarah
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Bjerrum, Lars
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Brehaut, Jamie
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Brown, Benjamin C.
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Bucher, Heiner C.
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De Sutter, An
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Francis, Nick
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Grimshaw, Jeremy
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Gunnarsson, Ronny
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Hoye, Sigurd
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Ivers, Noah
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Lecky, Donna M.
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Lindbæk, Morten
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Linder, Jeffrey A.
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Little, Paul
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Michalsen, Benedikte Olsen
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O'Connor, Denise
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Pulcini, Celine
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Sundvall, Pär Daniel
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Lundgren, Pia Touboul
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Verbakel, Jan Y.
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Verheij, Theo J.
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Schwartz, Kevin L.
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Xu, Alice X.T.
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Alderson, Sarah
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Bjerrum, Lars
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Brehaut, Jamie
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Brown, Benjamin C.
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Bucher, Heiner C.
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De Sutter, An
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Francis, Nick
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Grimshaw, Jeremy
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Gunnarsson, Ronny
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Hoye, Sigurd
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Ivers, Noah
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Lecky, Donna M.
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Lindbæk, Morten
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Linder, Jeffrey A.
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Little, Paul
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Michalsen, Benedikte Olsen
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O'Connor, Denise
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Pulcini, Celine
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Sundvall, Pär Daniel
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Lundgren, Pia Touboul
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Verbakel, Jan Y.
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Verheij, Theo J.
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Schwartz, Kevin L., Xu, Alice X.T., Alderson, Sarah, Bjerrum, Lars, Brehaut, Jamie, Brown, Benjamin C., Bucher, Heiner C., De Sutter, An, Francis, Nick, Grimshaw, Jeremy, Gunnarsson, Ronny, Hoye, Sigurd, Ivers, Noah, Lecky, Donna M., Lindbæk, Morten, Linder, Jeffrey A., Little, Paul, Michalsen, Benedikte Olsen, O'Connor, Denise, Pulcini, Celine, Sundvall, Pär Daniel, Lundgren, Pia Touboul, Verbakel, Jan Y. and Verheij, Theo J. (2023) Best practice guidance for antibiotic audit and feedback interventions in primary care: a modified Delphi study from the Joint Programming Initiative on Antimicrobial resistance: Primary Care Antibiotic Audit and Feedback Network (JPIAMR-PAAN). Antimicrobial Resistance and Infection Control, 12 (1), [72]. (doi:10.1186/s13756-023-01279-z).

Record type: Article

Abstract

Background: primary care is a critical partner for antimicrobial stewardship efforts given its high human antibiotic usage. Peer comparison audit and feedback (A&F) is often used to reduce inappropriate antibiotic prescribing. The design and implementation of A&F may impact its effectiveness. There are no best practice guidelines for peer comparison A&F in antibiotic prescribing in primary care. 

Objective: to develop best practice guidelines for peer comparison A&F for antibiotic prescribing in primary care in high income countries by leveraging international expertise via the Joint Programming Initiative on Antimicrobial Resistance-Primary Care Antibiotic Audit and Feedback Network. 

Methods: we used a modified Delphi process to achieve convergence of expert opinions on best practice statements for peer comparison A&F based on existing evidence and theory. Three rounds were performed, each with online surveys and virtual meetings to enable discussion and rating of each best practice statement. A five-point Likert scale was used to rate consensus with a median threshold score of 4 to indicate a consensus statement. 

Results: the final set of guidelines include 13 best practice statements in four categories: general considerations (n = 3), selecting feedback recipients (n = 1), data and indicator selection (n = 4), and feedback delivery (n = 5). CONCLUSION: We report an expert-derived best practice recommendations for designing and evaluating peer comparison A&F for antibiotic prescribing in primary care. These 13 statements can be used by A&F designers to optimize the impact of their quality improvement interventions, and improve antibiotic prescribing in primary care.

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Accepted/In Press date: 21 July 2023
Published date: 29 July 2023
Additional Information: Funding Information: This work and the network is supported by Joint Programming Initiative on Antimicrobial Resistance (JPIAMR) administered through the Canadian Institute for Health Research (CIHR) Grant Number 448378. Publisher Copyright: © 2023, Crown.

Identifiers

Local EPrints ID: 481191
URI: http://eprints.soton.ac.uk/id/eprint/481191
PURE UUID: 26e0bd58-3f36-4ce9-81f5-c49f423fd6cd
ORCID for Nick Francis: ORCID iD orcid.org/0000-0001-8939-7312
ORCID for Paul Little: ORCID iD orcid.org/0000-0003-3664-1873

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Date deposited: 18 Aug 2023 16:31
Last modified: 12 Jul 2024 02:05

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Contributors

Author: Kevin L. Schwartz
Author: Alice X.T. Xu
Author: Sarah Alderson
Author: Lars Bjerrum
Author: Jamie Brehaut
Author: Benjamin C. Brown
Author: Heiner C. Bucher
Author: An De Sutter
Author: Nick Francis ORCID iD
Author: Jeremy Grimshaw
Author: Ronny Gunnarsson
Author: Sigurd Hoye
Author: Noah Ivers
Author: Donna M. Lecky
Author: Morten Lindbæk
Author: Jeffrey A. Linder
Author: Paul Little ORCID iD
Author: Benedikte Olsen Michalsen
Author: Denise O'Connor
Author: Celine Pulcini
Author: Pär Daniel Sundvall
Author: Pia Touboul Lundgren
Author: Jan Y. Verbakel
Author: Theo J. Verheij

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