Implementation of a delayed prescribing model to reduce antibiotic prescribing for suspected upper respiratory tract infections in a hospital outpatient department, ghana

Samuel Ghebrehewet*, Wendi Shepherd, Edwin Panford-Quainoo, Saran Shantikumar, Valerie Decraene, Rajesh Rajendran, Menaal Kaushal, Afua Akuffo, Dinah Ayerh, George Amofah

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)

Abstract

Background: High levels of antimicrobial resistance (AMR) in Ghana require the exploration of new approaches to optimise antimicrobial prescribing. This study aims to establish the feasibility of implementation of different delayed/back-up prescribing models on antimicrobial prescribing for upper respiratory tract infections (URTIs). Methods: This study was part of a quality improvement project at LEKMA Hospital, Ghana, (Dec 2019–Feb 2020). Patients meeting inclusion criteria were assigned to one of four groups (Group 0: No prescription given; Group 1; Patient received post-dated antibiotic prescription; Group 2: Offer of a rapid reassessment of patient by a nurse practitioner after 3 days; and Group 3: Post-dated prescription forwarded to hospital pharmacy). Patients were contacted 10 days afterwards to ascertain wellbeing and actions taken, and patients were asked rate the service on a Likert scale. Post-study informal discussions were conducted with hospital staff. Results: In total, 142 patients met inclusion criteria. Groups 0, 1, 2 and 3 had 61, 16, 44 and 21 patients, respectively. Common diagnosis was sore throat (73%). Only one patient took antibiotics after 3 days. Nearly all (141/142) patients were successfully contacted on day 10, and of these, 102 (72%) rated their experiences as good or very good. Informal discussions with staff revealed improved knowledge of AMR. Conclusions: Delayed/back-up prescribing can reduce antibiotic consumption amongst outpatient department patients with suspected URTIs. Delayed/back-up prescribing can be implemented safely in low and middle-income countries (LMICs).

Original languageEnglish
Article number773
Pages (from-to)1-11
Number of pages11
JournalAntibiotics
Volume9
Issue number11
DOIs
Publication statusPublished - Nov 2020

Bibliographical note

Funding Information:
In 2019, a health partnership between the UK Faculty of Public Health (Africa Special Interest Group) and Ghana Public Health Association secured a global volunteering grant from the Fleming Fund’s Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS), supported by Tropical Health and Education Trust (THET) and Commonwealth Pharmacists Association (CPA) to undertake a series of stewardship programmes at LEKMA hospital in Ghana. It was felt that there was an opportunity to try different models of antibiotic prescribing within a Ghana healthcare setting to understand what the barriers would be for implementation of a change to existing antibiotic prescribing practices in a low to middle-income country (LMIC) context. Theoretical work to understand challenges to tackling AMR in LMICs has demonstrated that a broad range of factors such as weak governance and poor regulatory measures, compounded by low public awareness of AMR and technological limitations to adequate surveillance, may present complexities not present in non-LMIC settings [2].

Funding Information:
This project was funded as part of the Commonwealth Partnerships for Antimicrobial Stewardship Scheme (CwPAMS) supported by Tropical Health and Education Trust (THET) and Commonwealth Pharmacists Association (CPA) using Official Development Assistance (ODA) funding, through the Department of Health and Social Care?s Fleming Fund. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, PHE, the Fleming Fund, the Department of Health and Social Care, THET or CPA.

Funding Information:
Funding: This project was funded as part of the Commonwealth Partnerships for Antimicrobial Stewardship Scheme (CwPAMS) supported by Tropical Health and Education Trust (THET) and Commonwealth Pharmacists Association (CPA) using Official Development Assistance (ODA) funding, through the Department of Health and Social Care’s Fleming Fund. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, PHE, the Fleming Fund, the Department of Health and Social Care, THET or CPA.

Publisher Copyright:
© 2020, MDPI AG. All rights reserved.

Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.

Keywords

  • Antimicrobial resistance (AMR)
  • Antimicrobial stewardship (AMS)
  • Delayed/back-up prescribing
  • Developing countries
  • Ghana
  • LMICs
  • Upper respiratory tract infections

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