Optimising interventions to reduce antibiotic prescribing for respiratory tract infections in primary care: a mixed-methods study
PHE ePoster Library. Sallis A. 09/12/19; 274399; 200
Ms. Anna Sallis
Ms. Anna Sallis
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Abstract Introduction
Most antibiotics in England are prescribed in primary care, with many prescribed inappropriately (i.e. unnecessarily or not according to guidelines) for respiratory tract infections. This study aimed to understand whether effective research interventions and national antimicrobial stewardship (AMS) interventions address the key theoretical and empirical barriers and facilitators to appropriate antibiotic prescribing, and to identify ways to improve these interventions.
We conducted two rapid reviews of studies in primary care: (i) qualitative studies of influences on antibiotic prescribing decisions, and (ii) research AMS interventions. We analysed the studies using the Theoretical Domains Framework, Behaviour Change Wheel and Behaviour Change Techniques (BCTs) Taxonomy. We compared the behavioural content of research interventions shown to be effective at changing prescribing and national interventions, and the extent to which they address key domains representing barriers and facilitators to appropriate prescribing. We conducted a focus group and survey with 15 stakeholders to identify suggestions to improve AMS interventions.
We identified 13 qualitative and 17 intervention studies (UK-based). Analysis showed national interventions address key theoretical domains and use a range of theoretically-congruent intervention functions and BCTs. Intervention improvements were generated by stakeholders and using the research evidence for effective interventions. 14 new intervention components were considered by stakeholders as likely to be feasible, acceptable and effective.
Current AMS interventions have a good range of behavioural components which address key influences on behaviour but some barriers to appropriate antibiotic prescribing remain unaddressed. The intervention suggestions may offer further ways to optimise antibiotic prescribing. External funding details
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