Abertawe Bro Morgannwg University Health Board
The project aims to reduce the rates of antibiotic prescribing in primary care and the variation in prescribing amongst GP practices, year on year, through a number of interventions. A key intervention was to target the 10% of practices with the highest rates of antibiotic prescribing.
Despite significant work to improve antimicrobial prescribing over a number of years, Abertawe Bro Morgannwg University Health Board (ABMUHB) continues to demonstrate the highest rate of prescribing of antibacterial agents and also shows significant variation between practices. This included a focus on antibacterials during annual prescribing visits and educational events such as Prescribing Leads meetings.
Analysis / Problem Solving Methods / Approach
The Big Fight Campaign was introduced with the primary aim of intensifying the approach to improve patient outcomes and minimise the potential risks of increasing antibiotic resistance and C. difficile infection (CDi) through the development and implementation of a multidisciplinary programme.
The scale and scope of the Big Fight Campaign is significant. For it to have any chance of succeeding it was important to identify some initial interventions to implement, learn from and scale up. Within the GP practice work stream, four key interventions were identified, one of which was the targeted prescribing meetings for the top 10% of prescribers of antibacterials.
Goals & Targets
Key outcome measures for the Campaign for first year are:
A reduction in overall antibacterial prescribing in primary care across ABMUHB by at least 1 percentage point better than the Welsh national average trend (December quarter 2016 vs December quarter 2015).
A reduction in variation of overall antibacterial prescribing in primary care across ABMUHB between December quarter 2015 and December quarter 2016.
Seven of the highest prescribing practices (A to G) were visited by the Big Fight Antimicrobial Pharmacist in the first 3 months of the Campaign (represents 10% of GP practices in the ABMUHB Localities). The majority showed a reduction in prescribing above that seen in other practices. As a consequence, this intervention was seen to be effective and therefore extended to additional GP practices.
By targeting high prescribers, this was felt to be an intervention that would contribute to a reduced variation in prescribing.
Interventions / Actions
A standard presentation was developed focusing on key aspects of antimicrobial prescribing. A series of graphs with benchmarking antimicrobial prescribing data at a GP Cluster and GP Practice level was included in each presentation. The presentation provided the basis for discussion with GPs. The practice was asked to arrange a meeting to which all GPs and nurses were invited.
Discussions centered around challenges facing primary care and potential solutions and strategies to manage patients expectations for antibiotics, such as delayed prescription and patient information leaflets with safety netting advice and guidance on treating symptoms with remedies commonly found in the home.
During the presentation GPs were invited to share individualised prescribing data and discuss amongst colleagues in the practice.
Benefit / Impact / Outcomes
Following an evaluation of the intervention in September it was felt this intervention was delivering tangible outcomes and should be extended to other practices.
The number of practices visited by the Big Fight team now exceeds 20% and a number of additional GP Practices have requested support from the Big Fight Team to discuss their prescribing.
In addition to a reduction in antimicrobial prescribing, there has also been a reduction in the variation of antibacterial prescribing.
The Big Fight Team have a better understanding of the cultural norms which are leading to the high rates of antibacterial prescribing. This is informing the materials and tools now being developed to support more sustainable change.
Part of Cohort Bevan Exemplar Projects 2015-16