Sangwan Robin, Neels Alicia J, Gwini Stella May, Saha Sajal K, Athan Eugene
School of Medicine, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia.
Research Department, University Hospital Geelong, Barwon Health, Geelong, VIC 3220, Australia.
Antibiotics (Basel). 2023 Mar 16;12(3):594. doi: 10.3390/antibiotics12030594.
Sustained behaviour change and practice improvements for the optimal use of antimicrobials remains challenging in primary care. In 2018, a simple antimicrobial stewardship education programme involving guideline recommendations for common infections, antimicrobial audit reports, and local antibiograms resulted in significant improvements in guideline compliance and more appropriate antimicrobial prescribing by GPs. This observational follow-up study aims to examine the sustainability of the positive intervention effect after two years of implementation of the intervention. Practice-based data on all oral antimicrobial prescriptions issued by GPs were collected retrospectively to compare with intervention data and to measure the sustainability of the intervention effect. The data were analysed using a two-sample test of proportions. The primary outcomes included changes in the rate of prescription compliance with the Australian "Therapeutic Guidelines: Antibiotic" and the appropriateness of antimicrobial choice and duration of therapy. Overall, there was a significant decline in guideline compliance, from 58.5 to 36.5% (risk ratio (RR) (95% CI): 0.62 (0.52-0.74)), in the appropriateness of antimicrobial choice, from 92.8 to 72.8% (0.78 (0.73, 0.84)), and in the prescribed duration, from 87.7 to 53.3% (0.61 (0.54, 0.68)) in the intervention follow-up period. In respiratory infections and ear, nose, and throat infections, the rates of guideline compliance and appropriate choice and duration of antimicrobial prescription decreased significantly at < 0.001. Appropriateness in the duration of antimicrobial therapy also significantly decreased for most antimicrobials. The evidence suggests that a simple and single-occasion antimicrobial stewardship education programme is probably not enough to sustain improvements in the optimal use of antimicrobials by GPs. Future research is needed to validate the results in multiple GP clinics and to examine the effect of sustained education programmes involving infection-specific and antimicrobial-targeted audits and feedback.
在初级医疗保健中，实现持续的行为改变和改进抗菌药物的最佳使用实践仍然具有挑战性。2018年，一项简单的抗菌药物管理教育计划，包括针对常见感染的指南建议、抗菌药物审计报告和当地抗菌谱，使全科医生在指南依从性和更合理的抗菌药物处方方面有了显著改善。这项观察性随访研究旨在检验干预措施实施两年后积极干预效果的可持续性。回顾性收集全科医生开具的所有口服抗菌药物处方的基于实践的数据，以与干预数据进行比较，并衡量干预效果的可持续性。使用两样本比例检验对数据进行分析。主要结果包括符合澳大利亚《治疗指南：抗生素》的处方率变化、抗菌药物选择的适当性以及治疗持续时间。总体而言，在干预随访期间，指南依从性从58.5%显著下降至36.5%（风险比（RR）（95%置信区间）：0.62（0.52 - 0.74）），抗菌药物选择的适当性从92.8%下降至72.8%（0.78（0.73，0.84）），规定的治疗持续时间从87.7%下降至53.3%（0.61（0.54，0.68））。在呼吸道感染以及耳、鼻、喉感染中，指南依从性、抗菌药物处方的适当选择和持续时间的比率在<0.001水平上显著下降。大多数抗菌药物的抗菌治疗持续时间的适当性也显著下降。证据表明，一个简单的一次性抗菌药物管理教育计划可能不足以维持全科医生在抗菌药物最佳使用方面的改善。未来需要开展研究，以在多个全科诊所验证这些结果，并研究涉及特定感染和抗菌药物针对性审计及反馈的持续教育计划的效果。
