Successful improvement of antibiotic prescribing at Primary Care in Andalusia following the implementation of an antimicrobial guide through multifaceted interventions: An interrupted time-series analysis.

BACKGROUND: Most effective strategies designed to improve antimicrobial prescribing have multiple approaches. We assessed the impact of the implementation of a rigorous antimicrobial guide and subsequent multifaceted interventions aimed at improving antimicrobial use in Primary Care. METHODS: A quasi-experimental study was designed. Interventions aimed at achieving a good implementation of the guide consisted of the development of electronic decision support tools, local training meetings, regional workshops, conferences, targets for rates of antibiotic prescribing linked to financial incentives, feedback on antibiotic prescribing, and the implementation of a structured educational antimicrobial stewardship program. Interventions started in 2011, and continued until 2018. Outcomes: rates of antibiotics use, calculated into defined daily doses per 1,000 inhabitants-day (DID). An interrupted time-series analysis was conducted. The study ran from January 2004 until December 2018. RESULTS: Overall annual antibiotic prescribing rates showed increasing trends in the pre-intervention period. Interventions were followed by significant changes on trends with a decline over time in antibiotic prescribing. Overall antibiotic rates dropped by 28% in the Aljarafe Area and 22% in Andalusia between 2011 and 2018, at rates of -0.90 DID per year (95%CI:-1.05 to -0.75) in Aljarafe, and -0.78 DID (95%CI:-0.95 to -0.60) in Andalusia. Reductions occurred at the expense of the strong decline of penicillins use (33% in Aljarafe, 25% in Andalusia), and more precisely, amoxicillin clavulanate, whose prescription plummeted by around 50%. Quinolones rates decreased before interventions, and continued to decline following interventions with more pronounced downward trends. Decreasing cephalosporins trends continued to decline, at a lesser extent, following interventions in Andalusia. Trends of macrolides rates went from a downward trend to an upward trend from 2011 to 2018. CONCLUSIONS: Multifaceted interventions following the delivering of a rigorous antimicrobial guide, maintained in long-term, with strong institutional support, could led to sustained reductions in antibiotic prescribing in Primary Care.

[Identification of new and emerging technologies]. / Identificación de tecnologías nuevas y emergentes.

OBJECTIVE: Analyze the correspondence between health technologies (HT) to develop --doctor's opinion-- and the ones assessed by Spanish Agencies for Health Technologies Assessment. DESIGN: Response analysis of HT obtained from participant doctors. Comparison with assessment reports of agencies. SETTING: Andalusian Public Health System; 2003. Spanish Agencies for Health Tecnologies Assessment. PARTICIPANTS: One hundred and forty-seven specialised doctors of 46 MIR specialties. METHOD: Non-random sample. Andalusian experts and leaders professional selected. Exhaustive searching in Internet or assessment reports of HT. A "score of effort" (SE) was calculated for each Agency. RESULTS: Seven HT groups agree with agency assessment reports: systems and communication network (SE, 0.78%-6.25%); mollecular biology for diagnosis and treatment (SE, 3.12%-42.73%); functional image technologies, monitorization, quick diagnosis, and non-invasive methods (SE, 3.93%-31.25%); lasertherapy, microsurgery, endoscopic surgery, minimally invasive, virtual and remote-controlled surgery (SE, 3.22%-31.25%); stem cells, artificial organs, and xenotransplantation (SE, 0.78%-12.34%); psychosocial interventions (SE, 0.78%-7.69%); management, planification and record systems (SE, 9.67%-76.92%). Two additional cathegories not cited by doctors but evaluated by agencies were identified: Effectiveness of therapeutic and disgnostic implanted strategies and sterilization methods of surgical material (SE, 3.86%-43.18%); Matural drugs, alternative therapies (SE, 1.78%-6.25%). CONCLUSIONS: Greater concordance between doctors and agencies in: mollecular biology, functional image technology, new surgical techniques and management, planification and record systems.

Identificación de tecnologías nuevas y emergentes / Identification of new and emerging technologies

Objetivo. Analizar la correspondencia entre tecnologías sanitarias (TS) a desarrollar ­en opinión de médicos especialistas­ y las evaluadas por las agencias de evaluación de tecnologías españolas. Diseño. Análisis de respuestas sobre TS obtenidas de los médicos participantes. Comparación con informes de evaluación de las agencias. Emplazamiento. Sistema Sanitario Público Andaluz, Agencias Españolas de Evaluación de Tecnologías Sanitarias. Participantes. Se incluyó en el estudio a 147 especialistas de las 46 especialidades MIR. Método. Muestreo no probabilístico. Selección de expertos y líderes profesionales andaluces. Búsqueda exhaustiva en internet de informes de evaluación de tecnologías. Elaboración de indicador de esfuerzo dedicado por las agencias (IE). Resultados. Identificadas 7 categorías de TS coincidentes con las evaluaciones de agencias: sistemas y redes de comunicación (IE, 0,78-6,25%); biología molecular para diagnóstico y tratamiento (IE, 3,12-42,73%); tecnologías de imagen funcional, monitorización, diagnósticos rápidos y métodos no invasivos (IE, 3,93-31,25%); laserterapia, microcirugía, cirugía endoscópica, cirugía mínimamente invasiva y virtual teledirigida (IE, 3,22-31,25%); células madre, órganos artificiales y xenotrasplantes (IE, 0,78-12,34%); intervenciones psicosociales (IE, 0,78-7,69%); sistemas de información, planificación y gestión (IE, 9,67-76,92%). Se identificaron dos categorías no citadas evaluadas por las agencias (y efectividad de estrategias diagnósticas y terapéuticas implantadas y técnicas de esterilización de material quirúrgico (IE, 3,86-43,18%); drogas naturales, terapias alternativas (IE, 1,78-6,25%). Conclusiones. Mayor coincidencia entre profesionales y agencias en: biología molecular, tecnología de imagen funcional, nuevas técnicas quirúrgicas y planificación, gestión y sistemas de información

Objective. Analyze the correspondence between health technologies (HT) to develop --doctor's opinion-- and the ones assessed by Spanish Agencies for Health Technologies Assessment. Design. Response analysis of HT obtained from participant doctors. Comparison with assessment reports of agencies. Setting. Andalusian Public Health System; 2003. Spanish Agencies for Health Tecnologies Assessment. Participants. One hundred and forty-seven specialised doctors of 46 MIR specialties. Method. Non-random sample. Andalusian experts and leaders professional selected. Exhaustive searching in Internet or assessment reports of HT. A "score of effort" (SE) was calculated for each Agency. Results. Seven HT groups agree with agency assessment reports: systems and communication network (SE, 0.78%-6.25%); mollecular biology for diagnosis and treatment (SE, 3.12%-42.73%); functional image technologies, monitorization, quick diagnosis, and non-invasive methods (SE, 3.93%-31.25%); lasertherapy, microsurgery, endoscopic surgery, minimally invasive, virtual and remote-controlled surgery (SE, 3.22%-31.25%); stem cells, artificial organs, and xenotransplantation (SE, 0.78%-12.34%); psychosocial interventions (SE, 0.78%-7.69%); management, planification and record systems (SE, 9.67%-76.92%). Two additional cathegories not cited by doctors but evaluated by agencies were identified: Effectiveness of therapeutic and disgnostic implanted strategies and sterilization methods of surgical material (SE, 3.86%-43.18%); Matural drugs, alternative therapies (SE, 1.78%-6.25%). Conclusions. Greater concordance between doctors and agencies in: mollecular biology, functional image technology, new surgical techniques and management, planification and record systems