Optimising the quality of antibiotic prescribing in out-of-hours primary care in Belgium: a study protocol for an action research project

Annelies Colliers, Samuel Coenen, Hilde Philips, Roy Remmen, Sibyl Anthierens, Annelies Colliers, Samuel Coenen, Hilde Philips, Roy Remmen, Sibyl Anthierens

Abstract

Introduction: Antimicrobial resistance is a major public health threat driven by inappropriate antibiotic use, mainly in general practice and for respiratory tract infections. In Belgium, the quality of general practitioners' (GPs) antibiotic prescribing is low. To improve antibiotic use, we need a better understanding of this quality problem and corresponding interventions. A general practitioners cooperative (GPC) for out-of-hours (OOH) care presents a unique opportunity to reach a large group of GPs and work on quality improvement. Participatory action research (PAR) is a bottom-up approach that focuses on implementing change into daily practice and has the potential to empower practitioners to produce their own solutions to optimise their antibiotic prescribing.

Methods: This PAR study to improve antibiotic prescribing quality in OOH care uses a mixed methods approach. In a first exploratory phase, we will develop a partnership with a GPC and map the existing barriers and opportunities. In a second phase, we will focus on facilitating change and implementing interventions through PDSA (Plan-Do-Study-Act) cycles. In a third phase, antibiotic prescribing quality outside and antibiotic use during office hours will be evaluated. Equally important are the process evaluation and theory building on improving antibiotic prescribing.

Ethics: The study protocol was approved by the Ethics Committee of the Antwerp University Hospital/University of Antwerp. PAR unfolds in response to the needs and issues of the stakeholders, therefore new ethics approval will be obtained at each new stage of the research.

Dissemination: Interventions to improve antibiotic prescribing are needed now more than ever and outcomes will be highly relevant for GPCs, GPs in daily practice, national policymakers and the international scientific community.

Trial registration number: NCT03082521; Pre-results.

Keywords: action research; antibacterial agents; general practitioners; out-of-hours care.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
PAR (participatory action research) design of the BAbAR study (Better Antibiotic prescribing through Action Research). AB, antibiotics; APQI, antibiotic prescribing quality indicators; GP, general practitioner; GPC, general practitioner cooperative; OOH, out-of-hours; PDSA, Plan-Do-Study-Act.

References

    1. Howell L, Global Risks 2013: An Initiative of the Risk Response Network. Geneva: World Economic Forum, 2013.
    1. O’Neill J. Tackling a Crisis for the Health and Wealth of Nations: Wellcome Trust and UK Government, 2014.
    1. Malhotra-Kumar S, Lammens C, Coenen S, et al. . Effect of azithromycin and clarithromycin therapy on pharyngeal carriage of macrolide-resistant streptococci in healthy volunteers: a randomised, double-blind, placebo-controlled study. Lancet 2007;369:482–90. 10.1016/S0140-6736(07)60235-9
    1. Bartholomeeusen S. Morbidity research in primary care, using semi-automatic data collection from electronic medical records in general practices in Flanders. Leuven (Be: Catholic University Leuven, 2008.
    1. Adriaenssens N, Coenen S, Tonkin-Crine S, et al. . European Surveillance of Antimicrobial Consumption (ESAC): disease-specific quality indicators for outpatient antibiotic prescribing. BMJ Qual Saf 2011;20:764–72. 10.1136/bmjqs.2010.049049
    1. van der Velden AW, Pijpers EJ, Kuyvenhoven MM, et al. . Effectiveness of physician-targeted interventions to improve antibiotic use for respiratory tract infections. Br J Gen Pract 2012;62:801–7. 10.3399/bjgp12X659268
    1. Cross EL, Tolfree R, Kipping R. Systematic review of public-targeted communication interventions to improve antibiotic use. J Antimicrob Chemother 2017;72:975-987 epub 10.1093/jac/dkw520
    1. Arnold SR, Straus SE. Interventions to improve antibiotic prescribing practices in ambulatory care. Cochrane Database Syst Rev 2005:CD003539 10.1002/14651858.CD003539.pub2
    1. Aabenhus R, Jensen JUS, Jorgensen KJ, et al. . Biomarkers as point-of-care tests to guide prescription of antibiotics in patients with acute respiratory infections in primary care. Cochrane Db Syst Rev 2014.
    1. Coxeter P, Del Mar CB, McGregor L, et al. . Interventions to facilitate shared decision making to address antibiotic use for acute respiratory infections in primary care. Cochrane Database Syst Rev 2015:CD010907 10.1002/14651858.CD010907.pub2
    1. Antibiotics. Use them correctly and only when necessary!.
    1. Bapcoc. Belgische gids voor anti-infectieuzebehandeling in de ambulante praktijk.
    1. Belgian Antibiotic Policy Coordination Committee (BAPCOC).
    1. European Centre for Disease Prevention and Control. Antimicrobial consumption database (ESAC-Net).
    1. Balligand E, Costers M, Van Gastel E. Policy note 2014-2019. Belgian Antibiotic Policy Coordination Committee 2014. Federale Overheidsdienst Volksgezondheid: Veiligheid van de Voedselketen en Leefmilieu(Brussels).
    1. Coenen S, Costers M, De Corte S, et al. . The first European Antibiotic Awareness Day after a decade of improving outpatient antibiotic use in Belgium. Acta Clin Belg 2008;63:296–300. 10.1179/acb.2008.059
    1. Versporten A, Bolokhovets G, Ghazaryan L, et al. . Antibiotic use in eastern Europe: a cross-national database study in coordination with the WHO Regional Office for Europe. Lancet Infect Dis 2014;14:381–7. 10.1016/S1473-3099(14)70071-4
    1. Adriaenssens N, Bartholomeeusen S, Ryckebosch P, et al. . Quality of antibiotic prescription during office hours and out-of-hours in Flemish primary care, using European quality indicators. Eur J Gen Pract 2014;20:114–20. 10.3109/13814788.2013.828200
    1. Philips H, Remmen R, Van Royen P, et al. . What’s the effect of the implementation of general practitioner cooperatives on caseload? Prospective intervention study on primary and secondary care. BMC Health Serv Res 2010;10:222 10.1186/1472-6963-10-222
    1. Willems L, Denckens P, Philips H, et al. . Can we improve adherence to guidelines for the treatment of lower urinary tract infection? A simple, multifaceted intervention in out-of-hours services. J Antimicrob Chemother 2012;67:2997–3000. 10.1093/jac/dks336
    1. Debets VE, Verheij TJ, van der Velden AW, et al. . Antibiotic prescribing during office hours and out-of-hours: a comparison of quality and quantity in primary care in the Netherlands. Br J Gen Pract 2017;67:e178–e186. 10.3399/bjgp17X689641
    1. Huibers L, Moth G, Christensen MB, et al. . Antibiotic prescribing patterns in out-of-hours primary care: a population-based descriptive study. Scand J Prim Health Care 2014;32:200–7. 10.3109/02813432.2014.972067
    1. Adelman C. Kurt Lewin and the Origins of Action Research. Educational Action Research 1993;1:7–24. 10.1080/0965079930010102
    1. Meyer J. Qualitative research in health care. Using qualitative methods in health related action research. BMJ 2000;320:178–81. 10.1136/bmj.320.7228.178
    1. Reason P, Bradbury H. The SAGE Handbook of Action Research. London: SAGE, 2008.
    1. van Buul LW, Sikkens JJ, van Agtmael MA, et al. . Participatory action research in antimicrobial stewardship: a novel approach to improving antimicrobial prescribing in hospitals and long-term care facilities. J Antimicrob Chemother 2014;69:1734–41. 10.1093/jac/dku068
    1. Hart E, Bond M. Action research for health and social care: a guide to practice. Buckingham: Open University Press, 1995.
    1. Fals-Borda O, Action RM. Knowledge: Breaking the Monopoly With Participatory Action Research. London: Intermediate Technology publications, 1991.
    1. Waterman H, Tillen D, Dickson R, et al. . Action research: a systematic review and guidance for assessment. Health Technol Assess 2001;5:iii–157. 10.3310/hta5230
    1. Themessl-Huber M, Humphris G, Dowell J, et al. . Audio-visual recording of patient-GP consultations for research purposes: a literature review on recruiting rates and strategies. Patient Educ Couns 2008;71:157–68. 10.1016/j.pec.2008.01.015
    1. Jepson M, Salisbury C, Ridd MJ, et al. . The ‘One in a Million’ study: creating a database of UK primary care consultations. Brit J Gen Pract 2017.
    1. Koshy EKV, Waterman H. Action Research in Healthcare: SAGE Publications Inc, 2011.
    1. Colliers A, Bartholomeeusen S, Remmen R, et al. . Improving Care And Research Electronic Data Trust Antwerp (iCAREdata): a research database of linked data on out-of-hours primary care. BMC Res Notes 2016;9:259 10.1186/s13104-016-2055-x
    1. Coenen S, Gielen B, Blommaert A, et al. . Appropriate international measures for outpatient antibiotic prescribing and consumption: recommendations from a national data comparison of different measures. J Antimicrob Chemother 2014;69:529–34. 10.1093/jac/dkt385
    1. Reason P, Bradbury H. The SAGE Handbook of Action Research: Participative Inquiry and Practice Sage Publications Ltd. 2nd edition, 2008.
    1. Reed JE, Card AJ. The problem with Plan-Do-Study-Act cycles. BMJ Qual Saf 2016;25:147–52. 10.1136/bmjqs-2015-005076
    1. Tonkin-Crine S, Anthierens S, Hood K, et al. . GRACE INTRO/CHAMP consortium. Discrepancies between qualitative and quantitative evaluation of randomised controlled trial results: achieving clarity through mixed methods triangulation. Implement Sci 2016;11:66 10.1186/s13012-016-0436-0
    1. Anthierens S, Tonkin-Crine S, Cals JW, et al. . Clinicians' views and experiences of interventions to enhance the quality of antibiotic prescribing for acute respiratory tract infections. J Gen Intern Med 2015;30:408–16. 10.1007/s11606-014-3076-6
    1. Tonkin-Crine S, Anthierens S, Francis NA, et al. . Exploring patients' views of primary care consultations with contrasting interventions for acute cough: a six-country European qualitative study. NPJ Prim Care Respir Med 2014;24:14026 10.1038/npjpcrm.2014.26
    1. Little P, Stuart B, Francis N, et al. . Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial. Lancet 2013;382:1175–82. 10.1016/S0140-6736(13)60994-0
    1. Anthierens S, Tonkin-Crine S, Douglas E, et al. . General practitioners' views on the acceptability and applicability of a web-based intervention to reduce antibiotic prescribing for acute cough in multiple European countries: a qualitative study prior to a randomised trial. BMC Fam Pract 2012;13:101 10.1186/1471-2296-13-101
    1. Pinnock H, Barwick M, Carpenter CR, et al. . Standards for Reporting Implementation Studies (StaRI) Statement. BMJ 2017;356:i6795 10.1136/bmj.i6795
    1. Peters DH, Adam T, Alonge O, et al. . Implementation research: what it is and how to do it. Bmj-Brit Med J 2013:347.
    1. Peters DH, Tran N, Adam T. Implementation research in health: a practical guide Alliance for Health Policy and Systems Research, World Health Organization 2013.
    1. Rolfe G, Knowledge EN. Oxford: Butterworth Heinemann, 1998.
    1. Stad in Cijfers. Stad in Cijfers: zo zoekt u statistieken over de stad op.
    1. Kincheloe J, McLaren P. Rethinking critical theory and qualitative research Denzin NK and Lincoln YS (eds). Handbook of Qualitative Research, 1994:138–57.
    1. de Bont EG, Dinant GJ, Elshout G, et al. . An illness-focused interactive booklet to optimise management and medication for childhood fever and infections in out-of-hours primary care: study protocol for a cluster randomised trial. Trials 2016;17:547 10.1186/s13063-016-1667-8
    1. Dyrkorn R, Gjelstad S, Espnes KA, et al. . Peer academic detailing on use of antibiotics in acute respiratory tract infections. A controlled study in an urban Norwegian out-of-hours service. Scand J Prim Health Care 2016;34:180–5. 10.3109/02813432.2016.1163035
    1. Delaney BC, Peterson KA, Speedie S, et al. . Envisioning a learning health care system: the electronic primary care research network, a case study. Ann Fam Med 2012;10:54–9. 10.1370/afm.1313
    1. Friedman C, Rubin J, Brown J, et al. . Toward a science of learning systems: a research agenda for the high-functioning Learning Health System. J Am Med Inform Assoc 2015;22:43–50. 10.1136/amiajnl-2014-002977
    1. Delaney BC, Curcin V, Andreasson A, et al. . Translational Medicine and Patient Safety in Europe: TRANSFoRm--Architecture for the Learning Health System in Europe. Biomed Res Int 2015;2015:1–8. 10.1155/2015/961526
    1. Barkhuysen P, de Grauw W, Akkermans R, et al. . Is the quality of data in an electronic medical record sufficient for assessing the quality of primary care? Journal of the American Medical Informatics Association 2014;21:692–8. 10.1136/amiajnl-2012-001479
    1. van der Bij S, Khan N, Ten Veen P, et al. . Improving the quality of EHR recording in primary care: a data quality feedback tool. J Am Med Inform Assoc 2017;24:81–7. 10.1093/jamia/ocw054
    1. Meyer J. Evaluating action research. Age Ageing 2000;29 Suppl 2:8–10. 10.1093/oxfordjournals.ageing.a008104
    1. Tonkin-Crine S. Changing th prescibing behaviour of general practitioners: Understanding the acceptability and feasibility of interventions to promote prudent antibiotic use across Europe, 2012.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner