Evaluation Of Antibiotic Prescribing Trends, Knowledge, Self-Confidence And Impact Of Educational Intervention On Improving Antibiotic Prescribing In Upper Respiratory Tract Infections (Urtis) At Kota Setar District Public Health Clinics, Malaysia
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Date
2016-05
Authors
Md Rezal, Rabiatul Salmi
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Abstract
Improving antimicrobial use practice in primary care is a challenging task. Within this context, primary care practitioners in Malaysia need to be well educated on rational prescribing of these agents. This study explored the antibiotic prescribing trends, and evaluated the impact of simple intervention among prescribers towards their prescribing practice. The study comprised of combination of several phases including a baseline study of the antibiotic prescribing rates, a questionnaire survey assessing knowledge and self-confidence of the practitioners, followed by a single group interventional study for the antibiotic use pre- and post-educational program. A total of fifty-seven prescribers responded to the survey, with a response rate of 68.7%. Majority of the participants had good knowledge of the viral-aetiology of URTIs, 84% (n=48) and agreed antibiotics are not useful as a treatment (77%). However, 47% said it can reduce the complications and duration of the disease episodes (33%). Majority of the prescribers were confident with their knowledge regarding antibiotics (n=47, 85.9%), however 56.2% faced difficulties, and 75.5% relied on the opinion of their colleagues in selecting correct antibiotic for patients. The result revealed that prescribers had inadequate knowledge and misconceptions about antibiotic prescribing. Subsequently, 123,524 prescriptions from 1st January 2014 to 31st March 2014 were screened to assess the trends of antibiotic prescribing. During this period, there were 7129 of prescriptions were for URTI, with 31.8%
(n=2270) involved antibiotics. Tonsillitis, otitis media, and pharyngitis were listed as major conditions for which antibiotics were prescribed (91.3%, 89.8%, and 84.2%). Macrolides (erythromycin ethyl succinate), which are not recommended by the guidelines constituted 61% (n=1404) of total antibiotics prescribed, followed by the penicillins (n=794; 35%). It was also found that AMOs prescribed more macrolides compared to MOs and specialists. The final phase of the study involved creating a module for educating the prescribers, implementing it, and finally evaluates the impact towards reducing the rate of antibiotic prescribing. The impact concerning the educational session was elicited through the analysis of antibiotic prescribing rates pre-and post-intervention. Overall antibiotic prescribing reduced 27% during the first month post-intervention. Antibiotics use in tonsillitis (12.6%) and pharyngitis (10.9%) were also reduced, most notably the use of erythromycin. However, antibiotic prescribing rates have increased to the similar rate of the baseline at the end of third month post-intervention. In conclusion, successions of medical education are needed to develop confidence among the prescribers, in order to encourage the correct use of antibiotics. A comprehensive development of national antibiotic stewardship program with more extensive interventional module is expected to improve future antibiotic prescribing and ensure organised and regulated control of antibiotic use in Malaysia.
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Antibiotic prescribing trends, and evaluated the impact of simple intervention , among prescribers towards their prescribing practice.