Table 1 Advantages and disadvantage of AMS interventions in the primary care setting
From: Antimicrobial stewardship in the primary care setting: from dream to reality?
Core elements of AMS | AMS Interventions | Advantages | Disadvantages | Evidence of sustainability (study duration) |
|---|---|---|---|---|
Commitment | 1. Commitment poster in support of AMS [15] displayed in the waiting room and openly endorsed by the practice and its clinicians | Well received by the public. Provides standardised guidance & support for clinicians at a practice level. Low-cost, effective intervention. | Requires collaboration of clinicians at a practice level. | 3 months |
Action for practices | Reduces inappropriate antibiotic prescribing. | Need for an Electronic Health Record system to support a Clinical Decision support tool. Low uptake can be a barrier to effectiveness. | 6 to 18 months | |
2. Back-up (delayed or ‘wait and see’) prescribing [20,21,22,23,24] | Decreases antibiotic use. | Antibiotics can be utilized for conditions other than the original presentation. | 5 to 35 months | |
Decreases diagnostic uncertainty. Supports non-prescription decisions. Decreases inappropriate antibiotic use for viral infections. | Lack of reimbursement for point of care tests. Over-reliance or under-reliance on diagnostic tests. Difficulty of incorporating tests into current practice work flow. | 4 to 30 months | ||
Tracking and reporting | 1. Personalized audit and feedback to prescribers of antibiotic-prescribing rates in comparison to peers [16, 31,32,33,34] 2. Public reporting of antibiotic usage data [35] | Modifies prescribing behaviour. Reduces inappropriate prescribing. | Time consuming and increased resources are required for auditing process. Auditing process requires an Electronic Health Record system. Expertise required to validate and interpret data. | 6 months to 3 years |
Education and expertise | Patient education | Decreases antibiotic use. Improves patient satisfaction. | Time consuming for clinicians. | Limited length of observation |
Clinician education b. Communication training [26, 33, 38, 39] c. Peer academic detailing [40] | Promotes acceptance of AMS strategies. Tailored education such as communication training and peer academic training has proven to be effective in modifying prescriber behaviour. Effective with sustained benefits over time. Active, in-person education more effective than didactic education. Clinician education effectively supports other interventions. | Time consuming for clinicians. Lack of uptake by clinicians. | 4 months to 3 years |