Understanding antibiotic prescribing patterns in out-of-hours primary care

Despite current antimicrobial stewardship programmes there is evidence that out-of-hours antibiotic prescribing rates are increasing. We know communication plays a signi cant role in prescribing decisions in-hours; and that training promoting clear communication about symptoms and treatment is more likely to succeed. Our aim is to understand out-of-hours prescribing in real time from a sociological, clinical and organisational perspective.
Following a review of current policy, evidence and training, data will be collected from providers serving the South and West of England. Between 2018-19 we will collect 300 recordings from out- of-hours encounters - telephone calls, primary care centre visits and home visits - focused around the management common infections. Our sampling frame will include: independent prescribers (GPs, advanced nurse practitioners, prescribing pharmacists) and those using patient group directives (e.g., emergency care practitioners) and different patient groups. 50 stakeholders will be invited for focused interviews.
The literature review will focus on understanding the problem and its causes as well as assessing the evidence for current training. Analysis of real time interactions will focus on understanding communication patterns in uencing antibiotic outcomes. The stakeholder interviews will be used to support the development of enhanced communication training that will use real examples to guide practitioners’ prescribing behaviours.
This study brings together social science expertise from the SPCR Conversation Analysis Working Group and clinical expertise from researchers working in acute care, in collaboration with patients and out-of-hours service providers. The main output will be evidence-based communication training co-produced with key stakeholders to support prudent antibiotic prescribing out-of-hours.