Cutting ’unnecessary’ antibiotic prescriptions

A major University study which led to long-term reductions in the number of antibiotic prescriptions by Welsh GPs could see ’unnecessary’ prescriptions cut by 1.6M per year, if replicated across the UK.

The Stemming the Tide of Antimicrobial Resistance or STAR programme was designed by and implemented by experts from the University’s School of Medicine’s Institute of Primary Care and Public Health and South East Wales Trials Unit (SEWTU) to cut the number of unnecessary antibiotic prescriptions for common conditions such as acute cough and sinusitis.

Led by Professor Chris Butler, the two-year trial involved 68 practices across Wales covering some 480,000 patients offer ed GPs access to unique antibiotic prescribing and resistance data derived from their own practices and advanced ’consulting skills’ tools.

The learning tools, the result of over 15 years of work in infections and communication sciences by members of the Institute of Primary Care and Public Health team, are designed to enable GPs to discuss treatment options more effectively with their patients to better achieve evidence-based, shared and acceptable treatment decisions.

The study gave GPs access to on-line learning materials including videos, and allowed them the flexibility to learn and try out the new skills with their patients at times that were convenient to themselves.

"Antibiotic resistance remains one of the most important public health issues of our time, with antibiotic prescribing driving up resistance," said Professor Butler, who led the study.

"As most antibiotics are prescribed in General Practice, safely reducing the number of unnecessary prescriptions is essential. The STAR programme helped Welsh GPs gain new skills derived from motivational ing so they could achieve evidence-based treatment while taking patient perspectives into account.

"Although the percentage reduction in antibiotic prescribing was fairly small, based on national population estimates, if the findings of this study were replicated across the whole of Wales this would imply a reduction of well over 78,000 dispensed oral antibiotic items per year, and if replicated across the UK, a reduction of over 1.6M dispensed oral antibiotic items per year," he added.

The study, published in the British Medical Journal (BMJ), resulted in fewer oral antibiotics for all indications dispensed for a whole year for practices where GPs had undergone STAR training.

Patients in the STAR practices did not experience detectable increases in complications, hospital admissions, re-consultation rates, or costs associated with fewer antibiotics.

Professor Butler adds: "STAR’s achievement in reducing antibiotic prescribing is significant because it has shown signs of success where other efforts such as public health campaigns on antibiotic awareness have failed: despite these campaigns, antibiotic prescribing in the community in the UK appears again to be increasing.

"The STAR intervention goes to the heart of the philosophical foundations of general practice as it is based on patient data from the practices themselves, the best scientific evidence, and effective communication with patients.

"We have shown that fewer oral antibiotics for all indications were dispensed for a whole year for practices where clinicians had undergone STAR training."