Delayed Antibiotic Prescribing in Primary Care

Prescribing antibiotics for self-limiting upper respiratory infections is unfortunately common practice among primary care providers (PCP) in the US. Inappropriate use of antibiotics leads to the formation of resistant organisms, which have been increasing worldwide. Delayed antibiotic prescribing (DAP) is a method PCPs can use to reduce antibiotic consumption and subsequent resistant bacteria. The purpose of this project was to educate and encourage PCPs to integrate DAP into routine practice. Project objectives were to (a) increase PCP's knowledge of DAP, (b) assess providers' opinions, barriers, and motivation to use DAP following an educational presentation, and (c) disseminate the project to peers through a professional poster or podium presentation. The literature demonstrates that DAP methods, when used for patients with diagnoses of uncomplicated upper respiratory tract infections, reduce the amount of antibiotics consumed by patients. Existing DAP methods have proven to be effective, yet have not been fully integrated into routine practice. PCPs report risk of under-treating an unclear diagnosis, pressure from patients, time constraints, and potentially sending mixed messages to patients as barriers to DAP. The first objective was executed by creating and presenting an educational presentation, administering a pre- and post-test, and offering a handout to providers. The second objective was implemented by administering a questionnaire to evaluate the providers' perceptions about DAP. Lastly, the third objective was implemented by submitting an abstract to a primary care conference. The educational module was presented to 10 PCPs at three local primary care clinics. The response rates to the pre-/post-tests and questionnaire were 100%. There was a statistically significant increase in participant knowledge following the educational intervention (p-value <0.05). The questionnaire data were summarized and responses showed that overall, providers agree that DAP is a safe and appropriate practice, supports patient autonomy, and can help reduce global antibiotic resistance. All participants reported that they will consider using DAP for upper respiratory tract infections, and would recommend the presentation to other providers. In summary, reducing inappropriate antibiotic use is under the control of clinicians. It can be difficult for clinicians to distinguish viral from bacterial infections in some cases. Patients are sick and may feel desperate to feel better as soon as possible, or have been trained to expect antibiotics. Together this can lead to a knee-jerk reaction to write for an antibiotic inappropriately. DAP offers clinicians and patients an appropriate alternative to this instinctive reaction.