Improving primary care antimicrobial stewardship by implementing a peer audit and feedback intervention in Cape Town community healthcare centres

• Published in: South African medical journal 2022-10, Vol.112 (10), p.812-818
• Main Authors: de Vries, E, Johnson, Y, Willems, B, Bedeker, W, Ras, T, Coetzee, R, Tembo, Y, Brink, A
• Format: Article
• Language: English
• Subjects: Antibiotics; community health care; Community health services; Control; Dosage and administration; Drug resistance in microorganisms; Drugs; Medical care; Prescribing; Primary health care; Quality management
• ISSN: 0256-9574; 2078-5135
• DOI: 10.7196/SAMJ.2022.v112i10.16397

Background The increasing prevalence of antibiotic resistance is a major threat to public health. Primary care, where 80% of antibiotics are consumed, is a pivotal setting to direct antimicrobial stewardship (AMS) efforts. However, the ideal model to improve antibiotic prescribing in primary care in low-resource settings is not known.Objective To implement a multidisciplinary audit and feedback AMS intervention with the aim to improve appropriate antibiotic prescribing at primary care level.Methods The intervention was implemented and monitored in 10 primary care centres of the Cape Town metropole between July 2017 and June 2019. The primary and secondary outcome measures were monthly adherence to a bundle of antibiotic quality process measures and monthly antibiotic consumption, respectively. Multidisciplinary audit and feedback meetings were initiated and integrated into facility clinical meetings. Two Excel tools were utilised to automatically calculate facility audit scores and consumption. Once a month, 10 antibiotic prescriptions were randomly selected for a peer review audit by the team. The prescriptions were audited for adherence to a bundle of seven antibiotic process measures using the standard treatment guidelines (STG) and Essential Medicines List (EML) as standard. Concurrently, primary care pharmacists monitored monthly antibiotic consumption by calculating defined daily doses (DDDs) per 100 prescriptions dispensed. Adherence and consumption feedback were regularly provided to the facilities. Learning collaboratives involving representative multidisciplinary teams were held twice-yearly. Pre-, baseline and post-intervention periods were defined as 6 months before, first 6 months and last 6 months of the study, respectively.Results The mean overall adherence increased from 19% (baseline) to 47% (post intervention) (p