The effectiveness of Community and Primary Care Education Interventions at Reducing Rates of Antibiotic Prescriptions

Running head: Antibiotic Prescriptions 1
The effectiveness of Community and Primary Care Education Interventions at Reducing
Rates of Antibiotic Prescriptions
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Antibiotic Prescriptions 2
Introduction
According to the World Health Organization (WHO) (2014), antibiotic resistance is a
worldwide public issue. Resistant bacteria are linked to increased incidences of disability,
death, and socioeconomic costs (WHO, 2014). Moreover, most of the acute Respiratory
infections (ARIs) are caused by overuse of antibiotics, but still, antibiotic prescriptions for
the disease are on the increase (Barnett & Linder, 2014). Studies have indicated that
inappropriate prescriptions of antibiotics are likely to cause severe drug impacts, high costs of
treatment, and the increase and transmission of resistant organisms (Centres for Disease
Control and Prevention (CDCP) (2013). CDCP (2013) found out that inappropriate use of
antibiotics is the primary cause of drug resistance. The increase in antimicrobial resistance
has become a global public health concern (WHO, 2014). There are fears that the resistance
in the future may increase to unprecedented levels which may interrupt important medical
procedures (Davies, Fowler, Watson, Livermore, & Walker, 2013).
Non-adherence to clinical procedures by healthcare experts has been found in multiple
settings. More specifically, the non-compliance to outlined guidelines has always been
evidenced in primary care (McDermott et al., 2014). Non-compliance to procedures in
primary care can result in multiple complications in addition to the deterioration of the
medical condition of the patient or the increase in the risk factors that influence the disorder.
As a result, several invention mechanisms have been proposed to foster compliance with
guidelines. Some of these are educational programmes and materials, and automated
delivered systems (McDermott et al., 2014). The objective of this paper is to ascertain the
effectiveness of Community and Primary Care Education Interventions at Reducing Rates of
Antibiotic Prescriptions by critically examining relevant literature.

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Methods
Relevant articles to the study topic were searched for using specific keywords such as
intervention, upper respiratory tract infection, acute respiratory infection, antibiotics,
prescriptions of antibiotics, and primary care. These keywords were keyed into specific
search engines namely Google Scholar, NCBI, and PubMed. Only articles published in
English and not older than five years were included in the search. Furthermore, the articles
had to be peer-reviewed and randomized control trials (RCTs). The research was conducted
between September and December 2018, and published journals were retrieved from the
databases after identification, evaluation and quality check. The articles were critiqued using
the CASP checklist for cohort studies.
Results
The study by Lee et al. (2017) examined the effectiveness of patient-focused education in
lowering antibiotic prescriptions for upper respiratory tract infection (URTIs) among grown
persons in Singapore and receiving primary care. The subjects under study had to be
diagnosed with URTI symptoms for a week or less. Therefore, the study addressed the
research question. The RCT was a most appropriate design for the study because it enables
the researcher to compare the efficacy of intervention with another to ascertain superiority.
The sample is relatively representative of the defined population because of its high rate of
the outcome. Charan and Biswas (2013) observe that the rates of outcome in cohort studies
help to determine sample size. For instance, data on antibiotic prescription were unavailable,
and thus the authors had to work with estimates of 10% to 30%. The patients were randomly
assigned to either the experimental or control arm by the use of sequential envelopes with
automatically generated tasks founded on essential block randomization. This ensured that
that selection bias was minimal (Sterne et al., 2016).

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Furthermore, the confounding effect of variations in the prescription practices of the general
practitioner was addressed by using randomization level instead of cluster level. A similar
procedure was used to classify all the participants into the study groups thus avoiding any
potential risk of bias (Lee et al., 2017). The study was approved by an ethical approval board,
and informed consent was obtained from the general practitioners’ clinics before the study.
Thus, the study met ethical considerations. Using the FORM technique of grading evidence,
the study by Lee et al. (2017) has scored grade B, implying that the body of evidence can be
relied upon but with caution because of the missing data on antibiotic prescriptions, and is
likely to affect the outcomes.
Elouafkaoui et al. (2016) conducted a cluster RCT to determine the efficiency of an audit and
feedback intervention in minimizing the prescription of antibiotics in general dental practices.
The study population consisted of all antibiotic prescribing NHS general dental practices in
Scotland. The risk factors for antibiotic prescriptions are also considered. This is an
indication that the study clearly addressed the research question (CASP, n.d.). The study used
the RAPiD cluster randomized controlled trial. This technique was the most appropriate for
the study because it ensured that the recruitment of trial subjects were not in contact with
each other, no self-report measures, and prohibited the researchers from influencing the rates
of antibiotic prescriptions in the feedback (McCambridge, Kypri, & Elbourne, 2014). All
these strengths of the design minimized the potential for any sources of bias linked to the
entire process of research. Thus, the RAPiD RCT was best suited for the study.
The sample size of the study was a representation of the target population because it achieved
80% power (Im & Halberda, 2013). Furthermore, the study assessed all antibiotic prescribing
NHS general dental practices in Scotland, hence the reason for the high power of the sample
size.