Work package 4

Improving antibiotic use in primary care: an inventory of quality assurance projects and behavioural studies

Work Package leader: Prof. Paul Little, University of Southampton 
 

 

 

 

Objectives

  1. To provide a systematic review of behavioural interventions aimed at primary care patients in terms of their specific features (duration, costs, type of strategy, conceptual basis) and outcomes (e.g. attitudes, intensions, expectation for antibiotics, consumption of antibiotics)
  2. To provide a systematic review of behavioural interventions aimed at medical professionals in terms of their specific features (duration, costs, type of strategy, conceptual basis) and outcomes (e.g. attitudes, intensions, quantity and quality of antibiotic use, costs, adverse outcomes, sustained effects, resistance rates)
  3. To explore the views of researchers, medical professionals, patients and policy makers in Northern, Southern and Eastern Europe on quality assurance and behavioural programs on rational antibiotic use in primary care
  4. To review national and international guidelines on lower respiratory tract infections, acute sore throat, sinusitis and otitis media.
     

Description of work
First, a systematic review of studies on behavioural interventions aimed at primary care patients was performed by searching the relevant databases (Web of Science, PsycLit, Medline, Cochrane). All relevant studies in high-income countries (Europe, but also North-America and Australia) were included. Analysis of these studies included an examination of strategies with an emphasis on how information about antibiotic use is framed and the theoretical underpinning of the interventions. Previously, most interventions had employed an educational format, increasing patients’ awareness about the side effects of antibiotic overuse at a public health level but not addressing the potential benefits of decreased antibiotic use for patients themselves. The review therefore has also addressed innovative intervention behavioural strategies developed in the context of related preventative interventions in primary care to identify potential improvements in the existing programs.

Second, a systematic inventory of quality assurance and behavioural programs for medical professionals in primary care was made, including all relevant studies in high-income countries. The literature was searched using the available databases and experts were contacted in the field concerning unpublished information. Extracted papers were critically assessed according to predetermined criteria. Quality of studies was rated according to levels of evidence and bias in the conduct of the studies. Results were systematically reviewed and summarised.

Third, researchers, prescribing leads, medical professionals, patients and policy makers / guideline developers in Northern, Southern en Eastern Europe were contacted and interviewed. Selection of medical professionals and patients for interviews was done within the primary care networks recruited in the GRACE project. Interviews were held in five networks, selected from the GRACE EU network  The coordinators of these networks helped to select and contact researchers, policymakers, and prescribing leads in their country for the interviews. The interviews and the interview schedule were coordinated with WP2 so that the range of experience and opinion at all levels of prescribing policy and practice were captured. The interviews were done by especially trained staff.  They used semi-structured interview guides. The interviews have explored experiences, opinions and attitudes towards behavioural programs aiming at a prudent use of antibiotics in primary care, and where relevant as discussion of how interventions were developed.
 

We have used standardised stimulus materials (e.g. examples of patient information) as the basis for discussion of the key elements of behavioural programs. Analysis of the results aimed at the identification of central phenomena related to the effects of behavioural programs and explored likely determinants of a successful implementation of these programs. Framework analysis was employed to permit comparison of views from different groups (researchers, medical professionals, patients and policy makers), different countries, and regarding each different element of behavioural programmes. 
A core common approach to feasible and acceptable behavioural interventions has been proposed in addition to identifying the elements required for local implementation.

Fourth, (inter)national guidelines on lower respiratory tract infections, otitis media, sinusitis and acute sore throat in outpatients were reviewed and compared. Guidelines were identified by searching for electronically available guidelines in Medline, Cochrane library and by consulting source persons from the General Practice Respiratory Infectious Network (GRIN), the European Respiratory Society (ERS), the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) and the USA by contacting the CDC. Guidelines were included if they had been published by a national or regional professional medical organization or other authoritative organizations. Per disease entity, guidelines were compared on basic characteristics, definitions, diagnostic criteria and antibiotic indications. Finally first-choice and second-choice antibiotics, duration and dosages were described.

Finally, we prepared one summary report and two scientific publications to be submitted in peer reviewed journals. In addition, an expert meeting has been organized in conjunction with the other WP’s to discuss important findings and recommendations of this systematic review.

Improving antibiotic use in primary care: an inventory of quality assurance projects and behavioural studies

Work Package leader: Prof. Paul Little, University of Southampton 
 

 

 

 

Objectives

  1. To provide a systematic review of behavioural interventions aimed at primary care patients in terms of their specific features (duration, costs, type of strategy, conceptual basis) and outcomes (e.g. attitudes, intensions, expectation for antibiotics, consumption of antibiotics)
  2. To provide a systematic review of behavioural interventions aimed at medical professionals in terms of their specific features (duration, costs, type of strategy, conceptual basis) and outcomes (e.g. attitudes, intensions, quantity and quality of antibiotic use, costs, adverse outcomes, sustained effects, resistance rates)
  3. To explore the views of researchers, medical professionals, patients and policy makers in Northern, Southern and Eastern Europe on quality assurance and behavioural programs on rational antibiotic use in primary care
  4. To review national and international guidelines on lower respiratory tract infections, acute sore throat, sinusitis and otitis media.
     

Description of work
First, a systematic review of studies on behavioural interventions aimed at primary care patients was performed by searching the relevant databases (Web of Science, PsycLit, Medline, Cochrane). All relevant studies in high-income countries (Europe, but also North-America and Australia) were included. Analysis of these studies included an examination of strategies with an emphasis on how information about antibiotic use is framed and the theoretical underpinning of the interventions. Previously, most interventions had employed an educational format, increasing patients’ awareness about the side effects of antibiotic overuse at a public health level but not addressing the potential benefits of decreased antibiotic use for patients themselves. The review therefore has also addressed innovative intervention behavioural strategies developed in the context of related preventative interventions in primary care to identify potential improvements in the existing programs.

Second, a systematic inventory of quality assurance and behavioural programs for medical professionals in primary care was made, including all relevant studies in high-income countries. The literature was searched using the available databases and experts were contacted in the field concerning unpublished information. Extracted papers were critically assessed according to predetermined criteria. Quality of studies was rated according to levels of evidence and bias in the conduct of the studies. Results were systematically reviewed and summarised.

Third, researchers, prescribing leads, medical professionals, patients and policy makers / guideline developers in Northern, Southern en Eastern Europe were contacted and interviewed. Selection of medical professionals and patients for interviews was done within the primary care networks recruited in the GRACE project. Interviews were held in five networks, selected from the GRACE EU network  The coordinators of these networks helped to select and contact researchers, policymakers, and prescribing leads in their country for the interviews. The interviews and the interview schedule were coordinated with WP2 so that the range of experience and opinion at all levels of prescribing policy and practice were captured. The interviews were done by especially trained staff.  They used semi-structured interview guides. The interviews have explored experiences, opinions and attitudes towards behavioural programs aiming at a prudent use of antibiotics in primary care, and where relevant as discussion of how interventions were developed.
 

We have used standardised stimulus materials (e.g. examples of patient information) as the basis for discussion of the key elements of behavioural programs. Analysis of the results aimed at the identification of central phenomena related to the effects of behavioural programs and explored likely determinants of a successful implementation of these programs. Framework analysis was employed to permit comparison of views from different groups (researchers, medical professionals, patients and policy makers), different countries, and regarding each different element of behavioural programmes. 
A core common approach to feasible and acceptable behavioural interventions has been proposed in addition to identifying the elements required for local implementation.

Fourth, (inter)national guidelines on lower respiratory tract infections, otitis media, sinusitis and acute sore throat in outpatients were reviewed and compared. Guidelines were identified by searching for electronically available guidelines in Medline, Cochrane library and by consulting source persons from the General Practice Respiratory Infectious Network (GRIN), the European Respiratory Society (ERS), the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) and the USA by contacting the CDC. Guidelines were included if they had been published by a national or regional professional medical organization or other authoritative organizations. Per disease entity, guidelines were compared on basic characteristics, definitions, diagnostic criteria and antibiotic indications. Finally first-choice and second-choice antibiotics, duration and dosages were described.

Finally, we prepared one summary report and two scientific publications to be submitted in peer reviewed journals. In addition, an expert meeting has been organized in conjunction with the other WP’s to discuss important findings and recommendations of this systematic review.

Paul Little