“Delayed prescribing – a feasible strategy to lower antibiotic use for respiratory tract infections in primary care” https://www.duo.uio.no/handle/10852/38102
Widespread use of antibiotics leads to development of antimicrobial resistance, an increasing threat to health worldwide. The strategy of delayed antibiotic prescribing reduces antibiotics use for respiratory tract infections (RTIs) in experimental settings. The overall aim of this thesis is to explore delayed antibiotic prescribing and its potential in reducing antibiotic use for RTIs in routine primary care.
In a Norwegian primary care setting, we did 1) a controlled trial among GPs on the antibiotics saving effect of recommending delayed prescribing through lectures/group discussion and through a computerised pop-up reminder, 2) a qualitative study among GPs, and 3) a questionnaire study among GPs issuing and patients receiving delayed prescriptions.
We found that GPs regard delayed prescribing as an acceptable strategy for reserving antibiotics to the cases where it turns out to be medically indicated, especially acute otitis and acute sinusitis. GPs have strict requirements as to which patients, for which diagnoses and in which situations they will issue delayed prescriptions, resulting in an infrequent use of the strategy. GPs who received the interventions issued 11% of the antibiotic prescriptions as delayed prescriptions, and 59% of these were dispensed from pharmacies. The interventions gave a statistically significant but clinically modest decrease (RR 0.97) in dispensed antibiotics, without any accompanying increase in prescribed antibiotics.
The use of delayed prescribing should be encouraged as a tool to adhere to treatment guidelines, especially in cases of acute otitis and acute sinusitis. Interventions to promote its use have little effect, and pop-up reminders are not to recommend as a sole intervention, but should be considered as part of multi-faceted interventions. Delayed prescribing’s potential in reducing antibiotic use seems to be low in our setting, presumably because of relatively low antibiotic prescribing rates and low patient expectation for antibiotics. The strategy’s potential should be assessed in advance of interventions to implement its use. Further research should focus on the clinical outcomes of delayed prescribing for acute sinusitis, and the effect of other intervention elements in the implementation of delayed prescribing.
Høye S, Gjelstad S, Lindbæk M. Effects of interventions to promote delayed prescribing for respiratory tract infections on antibiotic-dispensing rates Br J Gen Pract 2013; 63: e777-86. doi:10.3399/bjgp13X674468
Høye S, Frich JC, Lindbæk M. Delayed prescribing for upper respiratory tract infections: a qualitative study of GPs' views and experiences Br J Gen Pract 2010; 60: 907-12. doi:10.3399/bjgp10X544087
Høye S, Frich JC, Lindbæk M. Use and feasibility of delayed prescribing for respiratory tract infections: A questionnaire survey BMC Fam Pract 2011; 12:34. doi:10.1186/1471-2296-12-34