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

PLoS One. 2020 May 15;15(5):e0233062. doi: 10.1371/journal.pone.0233062. eCollection 2020.

Abstract

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Antimicrobial Stewardship / statistics & numerical data
  • Antimicrobial Stewardship / trends*
  • Decision Support Techniques
  • Drug Utilization / statistics & numerical data
  • Drug Utilization / trends
  • Humans
  • Inappropriate Prescribing / prevention & control
  • Inappropriate Prescribing / statistics & numerical data
  • Inappropriate Prescribing / trends
  • Interrupted Time Series Analysis
  • Practice Patterns, Physicians' / statistics & numerical data
  • Practice Patterns, Physicians' / trends*
  • Primary Health Care / statistics & numerical data
  • Primary Health Care / trends*
  • Spain

Substances

  • Anti-Bacterial Agents

Grants and funding

This work was supported by a research project from Instituto de Salud Carlos III (FISS), Spanish Ministry of Health (PI/10/01152), co-financed by the European Development Regional Found (FEDER); a research project from the Andalusian Regional Ministry of Health (PI-0160-2010), and by the Spanish Ministry of Health for the Implementation of Strategies for Patient Safety from the National Health System (Fondos de Cohesión, 2011), through the project “Prevention of bacterial resistances and the appropriate use of antimicrobials in the Andalusian Public Health Care System Centres”. RFU received PI/10/01152 and PI-0160-2010. JLM received “Fondos de Cohesión, 2011”.