Optimizing antibiotic prescribing in primary care settings in the UK: findings of a BSAC multi-disciplinary workshop 2009

Several UK resources, including the National Institute for Health and Clinical Excellence (NICE), Clinical Knowledge Summaries, the Infection Specialist Library, the HPA Management of Infection Guide, the Map of Medicine and the Royal College of General Practitioners (RCGP) web site, produce primary care antibiotic prescribing guidance. A BSAC 2009 workshop aimed to discuss how guidance could be best translated into practice using public and professional educational programmes. Workshop participants were asked to consider approaches within the context of a behaviour change model, in which readiness to change is recognized as a product of the individual's perception of the importance of change (the 'why' of change; 'Why should I change my antibiotic prescribing') and their confidence that they can achieve a change (the 'how' of change). Participants concluded that antibiotic education campaigns should be repeated during peak prescribing periods, should be located in pharmacies, clinical waiting areas and schools, and should be reinforced verbally during patient consultations for infections. Patients should receive clear information, ideally reinforced with leaflets, about the likely duration of symptoms, self-care and the likely benefits and harms of antibiotics. Education for clinicians needs to focus on increasing awareness of the importance of antibiotic resistance and providing tools to increase confidence in changing their prescribing. Videos are a useful tool for demonstrating good and poor communication skills and approaches to eliciting and addressing patient concerns and expectations. Well-designed patient information can facilitate consultations. Feedback and audit on antibiotic use to clinicians is essential; this can be facilitated by incentive schemes, especially if clinical records link diagnosis with prescriptions.