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Tackling the overuse of antibiotics: a call to action

(Update, Feb 27: Links to further reading have been added to the bottom of the post) The NPS recently launched an educa

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(Update, Feb 27: Links to further reading have been added to the bottom of the post)

The NPS recently launched an education initiative for health professionals as part of a new five-year effort to address “the critical issue” of antibiotic resistance. A campaign targeting the general public is due to start in April.

The NPS is encouraging health professionals to tell patients they are twice as likely to carry resistant bacteria after a course of antibiotics as someone who has not taken them. “It may help to explain that antibiotics are less likely to be effective if they need them to treat a severe infection in the near future,” says the NPS.

Meanwhile, in its latest Croakey update, the Primary Health Care Research and Information Service (better known as PHC RIS) reports on a recent randomised controlled trial in the UK, which suggests that interventions to tackle antibiotic prescribing can make a difference.

Hopefully the NPS will be evaluating the impact of its campaign, and releasing the results, so we can compare its impact with those of efforts elsewhere.

Update (13 Feb): The NPS has also drawn readers’ attention to a Swedish campaign that has been effective in reducing antibiotic prescribing, especially for preschool children. More details here and here.

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Overprescribing of antibiotics can be tackled, suggests UK program

Olga Anikeeva writes:

Over-prescribing of antibiotics has been identified as a key challenge for Australia’s health system by the AIHW. While an awareness campaign in 2006-2008 contributed to a reduction in the number of antibiotic prescriptions, numbers rose again following the swine flu epidemic in 2009.

Currently, Australians are estimated to be one of the highest users of antibiotics in OECD countries, with health professionals dispensing approximately 22 million prescriptions annually, of which 3 million are for viral infections and therefore unnecessary.

A similar problem exists in the UK, which prompted researchers to assess the effectiveness of a flexible, multifaceted educational intervention aimed at reducing antibiotic over-prescribing in primary care.

The Stemming the Tide of Antibiotic Resistance (STAR) programme included a range of learning methods, such as reflection on own practice, provision of research evidence and guidelines and an online forum for sharing experiences and progress. Practitioners were able to access the online resource at any time that was convenient, including during patient consultations.

The intervention aimed to increase practitioners’ belief in the importance of changing their prescribing behaviour and confidence in their ability to make changes to the way they prescribe.

Compared to the control group, practices receiving the intervention displayed a significant reduction in total antibiotic dispensing in the year following the intervention after controlling for baseline antibiotic dispensing rate.

There were no significant differences in the number of hospital admissions for upper respiratory tract infections, general practice reconsultations and costs between the intervention and control groups.

Programme participants reported greater awareness of antibiotic resistance, increased self confidence in reducing prescribing and changes in their consultation style and prescribing behaviour.

The most influential components of the programme were the use of current research evidence, the presentation of consultation skills in online video format and the use of each practice’s own antibiotic dispensing rates in combination with local area data on resistance.

The STAR programme’s unique and multifaceted approach to practitioner education was found to be effective at reducing antibiotic over-prescribing, without a significant negative impact on hospital admissions, further general practice consultations or costs.

The programme could be applied in the Australian setting in order to address the challenges associated with high rates of antibiotic use.

• Olga Anikeeva is Research Associate at the Primary Health Care Research & Information Service (PHC RIS)

Butler CC, Simpson SA, et al. (2012). Effectiveness of multifaceted educational programme to reduce antibiotic dispensing in primary care: practice based randomised controlled trial. BMJ, 344: d8173

This article, which can be accessed at http://www.bmj.com/content/344/bmj.d8173?view=long&pmid=22302780, features in the 9 February 2012 edition of PHC RIS eBulletin, available at http://www.phcris.org.au/publications/ebulletin/index.php.

The eBulletin is designed to inform readers of recently published articles and reports, news items, media releases, upcoming conferences and courses, research grants, scholarships and fellowships, PHC RIS products and services and relevant websites in the primary health care field. Those interested in receiving the weekly eBulletin are invited to subscribe to the free service at http://www.phcris.org.au/mailinglists/index.php

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Previous PHC RIS columns at Croakey:

When doctors prescribe exercise, does it make any difference?

Caring for country is also good for Aboriginal people

The perils of surrogate markers

Are Australians willing to pay more for better oral health?

What helps encourage self-care for those with chronic illness?

More effort needed to strengthen shared care for people with serious mental illness

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Note from Croakey: When first published, this post referred to the “National Prescribing Service”, which is now known as the NPS. My apologies for this error.

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Update, 27 Feb:

• What are the options for treatment in a post-antibiotics era? John Rennie, the former editor-in-chief of Scientific American, investigates for Smart Planet. 

• Informed Health Online weighs up the pros and cons of antibiotics for sore throats

 

 

 

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