Evaluating academic detailing as an antibiotic stewardship intervention in primary healthcare settings in Croatia
Abstract 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...
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BMC
2024-12-01
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| Series: | BMC Primary Care |
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| Online Access: | https://doi.org/10.1186/s12875-024-02679-9 |
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| author | Darija Kuruc Poje Domagoj Kifer Maja Kuharić Katarina Gvozdanović Željka Draušnik Ana Posavec Andrić Vesna Mađarić Vlatka Janeš Poje Marina Payerl-Pal Arjana Tambić Andrašević Juraj Mark Poje Vesna Bačić Vrca Srećko Marušić |
| author_facet | Darija Kuruc Poje Domagoj Kifer Maja Kuharić Katarina Gvozdanović Željka Draušnik Ana Posavec Andrić Vesna Mađarić Vlatka Janeš Poje Marina Payerl-Pal Arjana Tambić Andrašević Juraj Mark Poje Vesna Bačić Vrca Srećko Marušić |
| author_sort | Darija Kuruc Poje |
| collection | DOAJ |
| description | Abstract 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. |
| format | Article |
| id | doaj-art-e3edce7c60d94821a5a09f74c2506af9 |
| institution | Kabale University |
| issn | 2731-4553 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Primary Care |
| spelling | doaj-art-e3edce7c60d94821a5a09f74c2506af92025-01-05T12:42:09ZengBMCBMC Primary Care2731-45532024-12-0125111310.1186/s12875-024-02679-9Evaluating academic detailing as an antibiotic stewardship intervention in primary healthcare settings in CroatiaDarija Kuruc Poje0Domagoj Kifer1Maja Kuharić2Katarina Gvozdanović3Željka Draušnik4Ana Posavec Andrić5Vesna Mađarić6Vlatka Janeš Poje7Marina Payerl-Pal8Arjana Tambić Andrašević9Juraj Mark Poje10Vesna Bačić Vrca11Srećko Marušić12Department of Pharmacy, General Hospital “dr. Tomislav Bardek”Department of Biophysics, Faculty of Pharmacy and Biochemistry, University of ZagrebDepartment of Medical Social Sciences, Feinberg School of Medicine, Northwestern UniversityDepartment of pharmacoepidemiology, Teaching Institute for Public Health “Dr Andrija Štampar”Division of Public Health, Croatian Institute of Public HealthPrimary Care Clinic, Koprivnica-Križevci CountyDepartment of Pulmology and Infectology, General Hospital “dr. Tomislav Bardek”Department of Clinical Microbiology, Institute of Public Health County Koprivničko-križevačkaDepartment of Clinical Microbiology, Institute of Public Health County MeđimurjeDepartment of Clinical Microbiology, School of Dental Medicine, The University Hospital for Infectious Diseases, Zagreb, Croatia and School of Dental Medicine, University of ZagrebDepartment of Neurology, General Hospital “dr. Tomislav Bardek”Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of ZagrebDepartment of Endocrinology, University hospital Dubrava, Zagreb, Croatia, and School of Medicine, and University of ZagrebAbstract 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.https://doi.org/10.1186/s12875-024-02679-9Antimicrobial resistanceAntibiotic prescribingPrimary careAcute respiratory tract infectionsAntimicrobial stewardshipAcademic detailing |
| spellingShingle | Darija Kuruc Poje Domagoj Kifer Maja Kuharić Katarina Gvozdanović Željka Draušnik Ana Posavec Andrić Vesna Mađarić Vlatka Janeš Poje Marina Payerl-Pal Arjana Tambić Andrašević Juraj Mark Poje Vesna Bačić Vrca Srećko Marušić Evaluating academic detailing as an antibiotic stewardship intervention in primary healthcare settings in Croatia BMC Primary Care Antimicrobial resistance Antibiotic prescribing Primary care Acute respiratory tract infections Antimicrobial stewardship Academic detailing |
| title | Evaluating academic detailing as an antibiotic stewardship intervention in primary healthcare settings in Croatia |
| title_full | Evaluating academic detailing as an antibiotic stewardship intervention in primary healthcare settings in Croatia |
| title_fullStr | Evaluating academic detailing as an antibiotic stewardship intervention in primary healthcare settings in Croatia |
| title_full_unstemmed | Evaluating academic detailing as an antibiotic stewardship intervention in primary healthcare settings in Croatia |
| title_short | Evaluating academic detailing as an antibiotic stewardship intervention in primary healthcare settings in Croatia |
| title_sort | evaluating academic detailing as an antibiotic stewardship intervention in primary healthcare settings in croatia |
| topic | Antimicrobial resistance Antibiotic prescribing Primary care Acute respiratory tract infections Antimicrobial stewardship Academic detailing |
| url | https://doi.org/10.1186/s12875-024-02679-9 |
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