Reducing antibiotic use in primary care: a pharmacist-led educational and audit & feedback strategy

Approved 14/07/2023, Balearic Islands Ethics Committee (c/Calçat, 2A, 2n, Palma, 07011, Spain; +34 971177378; ceic_ib@caib.es), ref: IB 5219/23 PI

Current primary outcome measure as of 06/01/2025:
The efficacy of the interventions on the prescription of antibiotics in the primary care area, measured using the number of antibiotic prescriptions extracted from the e-prescription databases of each health district at 12-month follow-up. The primary outcome will be measured as the total number of antibiotic prescriptions per 100 visits.

Previous primary outcome measure:
The efficacy of the interventions on the prescription of antibiotics in the primary care area, measured using the number of antibiotic prescriptions extracted from the e-prescription databases of each health district at 12-month follow-up

Current secondary outcome measures as of 07/05/2025:
1. Percentage of patients who start antibiotic treatment measured using the number of antibiotic prescriptions extracted from the e-prescription databases of each health district at 12-month follow-up.
2. Antibiotic prescription according to therapeutic group of antibiotics measured using number of antibiotic prescriptions according to therapeutic group (beta-lactams, glycopeptides, macrolides, aminoglycosides, tetracyclines, quinolones and fluoroquinolones, sulfonamides, lincosamides, oxazolidinones, polymyxins, rifamycins, nitroimidazoles, nitrofurans, fosfomycin) extracted from the e-prescription databases of each health district at 12-month follow-up.
3. Antibiotic prescription according to prescription pathology measured using the number of antibiotic prescriptions and their associated pathology (lower and upper respiratory infections, lower and upper urinary tract infections, sexually transmitted infections, skin and soft tissue infections, oral and odontogenic infections) at 12-month follow-up.
4. Antibiotic prescription according to gender measured using the number of antibiotic prescriptions extracted from the e-prescription databases of each health district, considering the gender of the GP and gender of the patient at 12-month follow-up.
5. The reach, engagement, adoption, fidelity and maintenance of the intervention. Reach will be defined as the percentage of participating GPs relative to the total number of eligible GPs. Engagement will measure the degree of active involvement in the intervention, including use of the feedback reports, participation in pharmacist-led sessions, and integration of recommendations into clinical practice. Adoption will be measured at the organizational level as the percentage of healthcare management units that have agreed to implement the intervention. Fidelity to the intervention will be assessed through audits of adherence to the planned feedback delivery process. This includes consistency in the timing and content of reports, implementation of pharmacist consultations, and completion of online training modules. Maintenance of the intervention will be assessed at 6 and 12 months post-intervention, focusing on the degree to which the intervention becomes institutionalized within the healthcare system.

Previous secondary outcome measures:
1. Percentage of patients who start antibiotic treatment measured using the number of antibiotic prescriptions extracted from the e-prescription databases of each health district at 12-month follow-up.
2. Antibiotic prescription according to therapeutic group of antibiotics measured using number of antibiotic prescriptions according to therapeutic group (beta-lactams, glycopeptides, macrolides, aminoglycosides, tetracyclines, quinolones and fluoroquinolones, sulfonamides, lincosamides, oxazolidinones, polymyxins, rifamycins, nitroimidazoles, nitrofurans, fosfomycin) extracted from the e-prescription databases of each health district at 12-month follow-up.
3. Antibiotic prescription according to prescription pathology measured using the number of antibiotic prescriptions and their associated pathology (lower and upper respiratory infections, lower and upper urinary tract infections, sexually transmitted infections, skin and soft tissue infections, oral and odontogenic infections) at 12-month follow-up.
4. Antibiotic prescription according to gender measured using the number of antibiotic prescriptions extracted from the e-prescription databases of each health district, considering the gender of the GP and gender of the patient at 12-month follow-up.
5. The reach of the intervention as well as the fidelity of the intervention execution. The reach of the intervention will be measured using the percentage of patients assigned to GPs, with any antibiotic prescription and eligible to receive the intervention at 12 months follow-up. The fidelity will be measured using a comprehensive record with a detailed description of the execution process and any adaptations made in each intervention, as well as the strategies they comprise at the 12-month follow-up.