Improving the quality of antibiotic prescribing through an educational intervention delivered through the out-of-hours general practice service in Ireland

Background: Antibiotic resistance is a threat to our health and health systems. Up to 70% of antibiotics are prescribed in general practice. In Ireland, Out-of-hours (OOH) services are mostly provided by co-operatives of GPs and the 11 main OOH centres cover up to 90% of the population. More than 80% of GPs are involved in OOH care in their area, which provides an opportunity to deliver education and awareness through this centralised system. Objectives: To analyse the change in the quality of antibiotic prescribing after the introduction of an educational intervention categorising antibiotics into a red (avoid) and green (preferred) panel. Methods: Educational information for the GP was developed based on the national prescribing guidelines. A particular focus was to reduce co-amoxyclav prescribing. An electronic pop-up message to record whether an antibiotic was prescribed, was displayed at the end of each consultation in the patient management software of the OOH-centre, after the decision of prescribing was made. Antibiotic prescribing was compared for a 13-week period (week 47–week 7) in 2016/2017 with 2017/2018. Results: Pre-intervention prescribing of red antibiotics was 44% which reduced to 17% after the intervention. The mean percentage of co-amoxyclav, the most prescribed non-firstline prescription, was 33% of all antibiotic prescriptions which dropped to 10%. Conclusion: Our intervention implemented in the OOH GP service categorised antibiotics into red prescriptions and green (firstline) prescriptions, which was recorded through an electronic pop-up message, resulted in an absolute reduction of 27% in red prescriptions and more than 23% in co-amoxyclav prescriptions.