Allison Rosalie, Lecky Donna M, Beech Elizabeth, Costelloe Céire, Ashiru-Oredope Diane, Owens Rebecca, McNulty Cliodna A M
Public Health England, UK.
NHS Improvement, London, UK.
JAC Antimicrob Resist. 2020 May 14;2(2):dlaa020. doi: 10.1093/jacamr/dlaa020. eCollection 2020 Jun.
To identify and explore strategies that English NHS commissioning organizations implemented to improve antimicrobial stewardship (AMS) within primary care.
Questionnaire sent to the medicines management teams (MMTs) of all 209 clinical commissioning groups (CCGs) in England, in 2017.
A total of 89% (187/209) of all English CCGs responded to the questionnaire; 74% of responding CCGs (123/167) had a prescribing incentive/engagement scheme, with MMTs representing 88% (90/102) considering incentive schemes successful or very successful for prioritizing AMS in primary care, especially when linked to prescribing NHS Quality Premium indicators. AMS audits were considered successful or very successful by 91% (126/138) of responding CCGs, as they identify reasons for inappropriate prescribing and opportunities for future improvement. All responding MMTs (169/169 CCGs) reported feeding back local/national antimicrobial prescribing data to the general practices they commission, 85% (142/168) to their CCG/Commissioning Support Unit (CSU) board and only 33% (56/169) to out-of-hours services. Benchmarking prescribing data was reported as a powerful tool to engage practices, facilitating an element of competition and peer pressure.
National antimicrobial resistance improvement schemes, in particular the NHS England Quality Premium, have influenced CCG improvement priorities. Most CCGs now report successful improvement strategies including the use of both local and national antibiotic prescribing data to motivate improvements; these should be continued and extended to out-of-hours providers. As local audit data have helped to identify reasons for inappropriate prescribing and inform improvement planning, all organizations should adopt this strategy and include it in local quality improvement schemes, ensuring performance reporting to organizational board level.
识别并探索英国国民健康服务体系（NHS）委托组织在初级医疗保健中实施的改善抗菌药物管理（AMS）的策略。
2017年向英格兰所有209个临床委托小组（CCG）的药品管理团队（MMT）发送问卷。
共有89%（187/209）的英国CCG回复了问卷；74%的回复CCG（123/167）有处方激励/参与计划，其中88%（90/102）的MMT认为激励计划在将AMS列为初级医疗保健优先事项方面成功或非常成功，特别是与NHS质量提升指标的处方挂钩时。91%（126/138）的回复CCG认为AMS审计成功或非常成功，因为它们能找出不适当处方的原因和未来改进的机会。所有回复的MMT（169/169个CCG）报告称已将当地/全国抗菌药物处方数据反馈给他们所委托的全科诊所，85%（142/168）反馈给了其CCG/委托支持单位（CSU）委员会，而只有33%（56/169）反馈给了非工作时间服务机构。报告称，将处方数据进行基准对比是促使诊所参与的有力工具，能形成一定程度的竞争和同行压力。
国家抗菌药物耐药性改善计划，特别是英格兰NHS质量提升计划，已影响到CCG的改进重点。现在大多数CCG报告了成功的改进策略，包括利用当地和全国抗生素处方数据来推动改进；这些策略应继续实施并扩展到非工作时间服务提供者。由于当地审计数据有助于找出不适当处方的原因并为改进计划提供信息，所有组织都应采用这一策略并将其纳入当地质量改进计划，确保向组织董事会层面报告绩效情况。
