Decreasing Antibiotic use through a Joint Intervention Targeting Physicians and Pharmacists

Abstract

Aim: To decrease population antibiotic use through an educational intervention targeting primary care physicians’ and community pharmacists’ attitudes and knowledge. Methods: We designed a pragmatic cluster-randomized trial covering all National Health System primary care physicians and all community pharmacists’ in a region in the north of Portugal. The study protocol was registered on ClinicalTrials.gov (identifier: NCT02173509). Results: After adjustment for baseline values and comparison with the control group, the intervention was associated with a significant reduction in overall antibiotic use in the year following the intervention. The effect was most marked for tetracyclines, macrolides and cephalosporins. No statistically significant differences were observed for fluoroquinolone consumption. Conclusion: Multifaceted interventions involving physicians, pharmacists and general public proved effective in reducing antibiotic consumption in the population.

KEYWORDS:

• antibiotic consumption
• antibiotic policies
• community pharmacists
• educational interventions
• microbial resistance
• primary care physicians

Author contributions

F Roque, A Teixeira-Rodrigues, L Breitenfeld, A Figueiras, MT Herdeiro were responsible for designing the study. MT Herdeiro was the researcher responsible for the project grant. F Roque and A Teixeira-Rodrigues prepared the educational materials (Powerpoint, flyers and posters) for the intervention, which were revised by all the authors. F Roque conducted the pharmacist interventions and A Teixeira-Rodrigues conducted the physician interventions. F Roque, A Teixeira-Rodrigues, M Piñeiro-Lamas and A Figueiras analyzed the data, F Roque wrote the manuscript, and all authors were responsible for reviewing and revising the paper.

Acknowledgements

The authors wish to express their sincere thanks to all the physicians and pharmacists who agreed to participate in this study, and to the following organizations that lent scientific support to the study at the time it was being undertaken: the Central Region Official College of Pharmacists; the Official College of Physicians; and the Portuguese Association of Family Medicine. Thanks must also go to IMS Health^® for making the data on antibiotic consumption available, and for iBiMED (UID/BIM/04501/2013).

Disclaimer

The funders had no role in study design, data collection and analysis, nor in the drafting of this paper.

Financial & competing interests disclosure

This work was supported by a Foundation for Science & Technology (Fundação para a Ciência e Tecnologia [FCT]) grant (PTDC/SAU-ESA/105530/2008) from the Portuguese Ministry of Science & Education, and co-financed by FEDER through COMPETE Program. The funders had no role in study design, data collection and analysis, nor in the drafting of this paper. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Additional information

Funding

This work was supported by a Foundation for Science & Technology (Fundação para a Ciência e Tecnologia [FCT]) grant (PTDC/SAU-ESA/105530/2008) from the Portuguese Ministry of Science & Education, and co-financed by FEDER through COMPETE Program. The funders had no role in study design, data collection and analysis, nor in the drafting of this paper. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.