Successful improvement of antibiotic prescribing at Primary Care in Andalusia following the implementation of an antimicrobial guide through multifaceted interventions: An interrupted time-series analysis.

Autor: Fernández-Urrusuno R; Clinical Unit Primary Care Pharmacy Sevilla, Aljarafe-Sevilla Norte Primary Health Care Area, Andalusian Public Health Care Service, Seville, Spain., Meseguer Barros CM; Service of Pharmacy, Ouest Primary Health Care Area, Madrid Public Health Service, Madrid, Spain., Benavente Cantalejo RS; Promotion and Rational Use of Drugs Service, General Direction of Pharmacy, Andalusian Public Health Care Service, Seville, Spain., Hevia E; Promotion and Rational Use of Drugs Service, General Direction of Pharmacy, Andalusian Public Health Care Service, Seville, Spain., Serrano Martino C; Microbiology Service, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, Spain., Irastorza Aldasoro A; General Direction of Health Care and Health Outcomes, Andalusian Public Health Care Service, Seville, Spain., Limón Mora J; General Direction of Health Care and Health Outcomes, Andalusian Public Health Care Service, Seville, Spain., López Navas A; Coordination Unit of the Spanish National Action Plan on Antimicrobial Resistance, Spanish Medicines Agency and Health Products, Madrid, Spain., Pascual de la Pisa B; Clinical Unit Camas, Andalusian Public Health Care Service, Camas, Seville, Spain.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2020 May 15; Vol. 15 (5), pp. e0233062. Date of Electronic Publication: 2020 May 15 (Print Publication: 2020).
DOI: 10.1371/journal.pone.0233062
Abstrakt: Background: Most effective strategies designed to improve antimicrobial prescribing have multiple approaches. We assessed the impact of the implementation of a rigorous antimicrobial guide and subsequent multifaceted interventions aimed at improving antimicrobial use in Primary Care.
Methods: A quasi-experimental study was designed. Interventions aimed at achieving a good implementation of the guide consisted of the development of electronic decision support tools, local training meetings, regional workshops, conferences, targets for rates of antibiotic prescribing linked to financial incentives, feedback on antibiotic prescribing, and the implementation of a structured educational antimicrobial stewardship program. Interventions started in 2011, and continued until 2018. Outcomes: rates of antibiotics use, calculated into defined daily doses per 1,000 inhabitants-day (DID). An interrupted time-series analysis was conducted. The study ran from January 2004 until December 2018.
Results: Overall annual antibiotic prescribing rates showed increasing trends in the pre-intervention period. Interventions were followed by significant changes on trends with a decline over time in antibiotic prescribing. Overall antibiotic rates dropped by 28% in the Aljarafe Area and 22% in Andalusia between 2011 and 2018, at rates of -0.90 DID per year (95%CI:-1.05 to -0.75) in Aljarafe, and -0.78 DID (95%CI:-0.95 to -0.60) in Andalusia. Reductions occurred at the expense of the strong decline of penicillins use (33% in Aljarafe, 25% in Andalusia), and more precisely, amoxicillin clavulanate, whose prescription plummeted by around 50%. Quinolones rates decreased before interventions, and continued to decline following interventions with more pronounced downward trends. Decreasing cephalosporins trends continued to decline, at a lesser extent, following interventions in Andalusia. Trends of macrolides rates went from a downward trend to an upward trend from 2011 to 2018.
Conclusions: Multifaceted interventions following the delivering of a rigorous antimicrobial guide, maintained in long-term, with strong institutional support, could led to sustained reductions in antibiotic prescribing in Primary Care.
Competing Interests: The authors have declared that not competing interests exist.
Databáze: MEDLINE
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