Evaluating academic detailing as an antibiotic stewardship intervention in primary healthcare settings in Croatia.

Autor: Poje DK; Department of Pharmacy, General Hospital 'dr. Tomislav Bardek', Željka Selingera 1, 4800, Koprivnica, Croatia. darija_kuruc@yahoo.com., Kifer D; Department of Biophysics, Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia., Kuharić M; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illionis, USA., Gvozdanović K; Department of pharmacoepidemiology, Teaching Institute for Public Health 'Dr Andrija Štampar', Zagreb, Croatia., Draušnik Ž; Division of Public Health, Croatian Institute of Public Health, Zagreb, Croatia., Andrić AP; Primary Care Clinic, Koprivnica-Križevci County, Koprivnica, Croatia., Mađarić V; Department of Pulmology and Infectology, General Hospital 'dr. Tomislav Bardek', Koprivnica, Croatia., Poje VJ; Department of Clinical Microbiology, Institute of Public Health County Koprivničko-križevačka, Koprivnica, Croatia., Payerl-Pal M; Department of Clinical Microbiology, Institute of Public Health County Međimurje, Čakovec, Croatia., Andrašević AT; Department of Clinical Microbiology, School of Dental Medicine, The University Hospital for Infectious Diseases, Zagreb, Croatia and School of Dental Medicine, University of Zagreb, Zagreb, Croatia., Poje JM; Department of Neurology, General Hospital 'dr. Tomislav Bardek', Koprivnica, Croatia., Vrca VB; Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia., Marušić S; Department of Endocrinology, University hospital Dubrava, Zagreb, Croatia, and School of Medicine, and University of Zagreb, Zagreb, Croatia.
Jazyk: angličtina
Zdroj: BMC primary care [BMC Prim Care] 2024 Dec 19; Vol. 25 (1), pp. 426. Date of Electronic Publication: 2024 Dec 19.
DOI: 10.1186/s12875-024-02679-9
Abstrakt: Background: Acute respiratory tract infections are common in primary healthcare care settings and frequently result in antibiotic prescriptions, despite being primarily viral. There is scarcity of research examining impact of academic detailing (AD) intervention on prescribing practices for these infections in resource-constrained healthcare settings like southeastern Europe. Therefore aim of this study was to evaluate impact of AD intervention as an antimicrobial stewardship measure on antibiotic prescribing for acute respiratory tract infections in primary setting in Croatia which is located in southeastern Europe. Secondary goal included examining incidence of Clostridioides difficile infections (CDI) which are often associated with antibiotic consumption.
Methods: AD intervention was implemented from 1st to 30th April 2020 and led by hospital healthcare professionals (infectious disease physician, clinical microbiology physician and clinical pharmacist). They focused on enhancing prescribing behaviors of primary care physicians (PCPs) by presenting local data, supplemented by examples from everyday practice, research and guidelines highlighting negative consequences of imprudent antibiotic use. This feasibility quasi-experimental study had two control groups in two counties. Impact of AD intervention was assessed by analyzing antibiotic prescription patterns using log-linear model, adjusting for seasonality. Study focused on prescribed daily defined doses (DDD) per day among PCPs pre-intervention (from 01st January 2018 to 31st March 2020) and post-intervention (from 1st May 2020 to 31st December 2022).
Results: Data was collected from sixteen out of fifty-seven eligible PCPs with mean 29 years (SD 11.38) in practice. Statistically significant difference results (p < 0.05) favored AD intervention, leading to 30% decline in antibiotic prescribing in adjusted DDD per day for acute pharyngitis (21.14 post-intervention/30.27 pre-intervention), 33% decline for acute tonsilitis (24.91/37.38), 23% decline for acute upper respiratory infection (21.26/27.62) and 36% decline for acute bronchitis (8.13/12.77). Although there was 14% decline for acute sinusitis post-intervention, it did not reach statistical significance (30.96/35.93) (p = 0.617). Incidence of CDI cases decreased in investigated county while in control county stayed the same. Inter-county difference in these changes was not statistically significant (ratio = 0.749, 95% CI, 0.460-1.220; p = 0.246).
Conclusions: This feasibility study showed reductions in antibiotic prescribing for acute respiratory tract infections, emphasizing the efficacy of targeted, educator-led programs. Tailored healthcare strategies are vital, especially in Croatia and southeastern Europe, for promoting sustainable practices and addressing antimicrobial resistance challenges.
Competing Interests: Declarations. Ethics approval and consent to participate: The research underwent review and approval by the Regional Committee for Medical and Health Research Ethics for Outpatient Clinics of Koprivnica-Križevci County (reference number 2137–16-5266/2021). All participants provided informed consent. Additionally, we obtained ethical approval for data collection from Croatian Institute of Public Health (reference numbers 030–02/23–15/8 and 117–15-23–2), and informed consent was secured from all identified PCPs in KKC and BBC. No personal data of PCPs or patients were included. We identified prescriptions for patients diagnosed with ARI and AB linking them to PCPs using unique identifiers. Furthermore, adhering to STROBE-AMS guidelines, the study aimed to enhance reporting on the link between antimicrobial resistance and antibiotic use, contributing to ASP improvements [40, 41]. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.
(© 2024. The Author(s).)
Databáze: MEDLINE
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