Thursday, September 2, 2010

Improving quality of antibiotics’ prescription in primary care: a qualitative evaluation of combined training intervention

BMC Family Practice publishes this paper focused on an intervention designed to change primary healthcare professionals’ antibiotic prescription habits.

The educational STAR program (Stemming the Tide of Antibiotic Resistance) has the aims of improving antibiotics’ prescription and to increase the awareness of the problem of antibiotic resistance among primary care physicians.

STAR program is composed of five main parts, complemented by a forum in the web about the course (part 6), and a reinforcement session (part 7) given approximately six months after completing the main program of the course.

Parts 1 and 2 include an online-introduction to antibiotic resistance and prescription. Participants present their own points of view on the subject. Clinical cases are also presented to discuss as well as some of most recent scientific evidence (graphics and abstracts). The objective of these two first parts is to raise clinicians’ awareness on how they treat common infections in everyday practice.

Part 3 consists of a practical seminar, where attendants meet in presence of a STAR instructor who contributes to the discussion about their prescription habits and data on resistances, collected from samples offered by professionals during the five to ten years previous to the study.

Part 4 presents online videos reflecting clinical settings or patient simulations to show key communication skills to employ in practice, useful for better understanding patients’ attitudes, expectations and worries.

In part 5 physicians are asked to describe three examples of their own clinical experience and to think them over, in order to consolidate the achieved knowledge.

The program’s effectiveness was evaluated in a randomized controlled study in which 244 primary care physicians and nurses took part. This text shows part of the study’s evaluation.

Evaluation was performed by a partly structuralized telephone interview, with digital data registration, to a 31 participants sample, by means of analysis of contents.

The majority of subjects reported higher awareness of antibiotic resistance, greater self confidence to reduce antibiotics’ prescription and at least some change in practice and attitude towards antibiotics’ prescription. Reported changes in practice included adoption of some policy to decrease prescription of antibiotics. Many physicians also reported their increased interest in patients’ expectances that contributes to improve the relationship between patient and physician.

The parts of the intervention that showed greatest influence to change professional’s behaviour were the update of available evidence, the simple and effective communication skills presented on online videos, and self reporting of antibiotic prescription data, combined with showing local resistance data.

Participants considered this educational intervention acceptable, necessary and feasible, obtaining a great impact and positive changes in attitudes and in clinical practice as a result of participation in STAR educational program.


Bekkers MJ, Simpson SA, Dunstan F, Hood K, Hare M, Evans J, et al. Enhancing the quality of antibiotic prescribing in primary care: qualitative evaluation of a blended learning intervention. BMC Fam Pract. 2010;11:34.





Posted by Lola Martín
English version by Erika Céspedes

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