The OPEN project
Research type
Research Study
Full title
The OPEN project: Out-of-hours Prescribing: Enhancing Communication
IRAS ID
250889
Contact name
Rebecca K Barnes
Contact email
Sponsor organisation
University of Bristol
Duration of Study in the UK
2 years, 5 months, 29 days
Research summary
Research Summary
The overuse and misuse of antibiotics in primary care is an increasing national and global concern due to the increasing risk of antimicrobial resistance (AMR) (when bacteria becomes resistant to treatments leading to increased risks of illness lasting longer, increased symptom severity and even death). In the UK, the NHS has invested in combating AMR via public health campaigns, clinical guidelines for treatment of common infections and local monitoring on numbers of antibiotics prescribed. In primary care, most of the research to-date has focussed on GP prescribing during usual surgery hours rather than prescribing out-of-hours (OoH), despite the fact that many different prescribing professionals work OoH, and evidence that antibiotic prescribing is increasing in this setting. Prior research has indicated that the ways that prescribers and patients (and sometimes their carers) talk to each other about medical problems can impact upon the ultimate treatment decision (i.e. whether antibiotics are prescribed or not). Moreover, training prescribers to communicate about antibiotics in ways that incorporate explanations about symptoms (e.g. how long a virus can last for) and treatment (e.g. why antibiotics might not be appropriate to treat a virus) has been shown to be effective in promoting less overuse and misuse.
Across three work streams this research will review relevant literature, record a range of different types of consultations that happen OoH (telephone calls, primary care centre visits and home visits) between different prescribers (GPs, nurses, pharmacists, paramedics) and patient groups (or parents / carers) with follow-up qualitative interviews across two organisations in the South and West of England to understand the treatment of common infections. Findings will be used to develop communication training that will guide clinicians (step-by-step) in how to discuss the treatment of common infections in ways that promote shared understandings about self-management and the appropriate use of antibiotics.
Summary of Results
Despite a slow reduction in antibiotic consumption within English general practice, other community prescribing has continued to rise with out-of-hours services showing the highest rates. Our aims were to understand challenges in the management of common infections in out-of-hours care in order to identify ways of supporting prudent antibiotic prescribing. In this study, a sample of telephone calls, primary care treatment centre appointments and home visits for patients with common infections were collected in two out-of-hours services serving large populations in the South and West of England between March 2019-March 2020. 220 audio and video-recordings of consultations for common infections (68 advice calls, 86 primary care treatment centre appointments and 66 home visits) were collected and analysed. Antibiotic prescribing patterns in our sample were compared against 12 months of anonymous database records collected from one service during the same time period. In our recordings, the most common problems were respiratory (45.0%), urinary (21.4%) and skin (14.1%) infections. Overall, antibiotics were prescribed 50.9% of the time (85.1% urinary; 51.5% skin; 50.6% respiratory, including ear problems). We identified four key communication challenges faced by prescribing clinicians during out-of-hours consultations: Managing patient expectations; promoting self-care; recommending 'delayed' or 'back up' antibiotic prescriptions; and giving safety-netting advice. We drew on existing research evidence, clinical guidelines and our own review of current training to develop a new communication-based e-learning programme for prescribers working in the out-of-hours setting. With input from Health Education England's (HEE) eLearning for Health team, out-of-hours clinicians, and patient and carer representatives, we developed four training modules to address each key communication challenge. The 'Antimicrobial Stewardship Out-of-Hours' programme is now freely accessible to individuals working in NHS health or care organisations to help support the prudent prescribing of antibiotics in this setting.
REC name
Wales REC 5
REC reference
18/WA/0413
Date of REC Opinion
21 Dec 2018
REC opinion
Favourable Opinion