Impact of the COVID-19 Pandemic on Community Antibiotic Prescribing and Stewardship: A Qualitative Interview Study with General Practitioners in England
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Abstract
The COVID-19 pandemic has had a profound impact on the delivery of primary care services. We aimed to identify general practitioners’ (GPs’) perceptions and experiences of how the COVID-19 pandemic influenced antibiotic prescribing and antimicrobial stewardship (AMS) in general practice in England. Twenty-four semi-structured interviews were conducted with 18 GPs at two time-points: autumn 2020 (14 interviews) and spring 2021 (10 interviews). Interviews were audio-recorded, transcribed and analysed thematically, taking a longitudinal approach. Participants reported a lower threshold for antibiotic prescribing (and fewer consultations) for respiratory infections and COVID-19 symptoms early in the pandemic, then returning to more usual (pre-pandemic) prescribing. They perceived the pandemic as having had less impact on antibiotic prescribing for urinary and skin infections. Participants perceived the changing ways of working and consulting (e.g., proportions of remote and in-person consultations) in addition to changing patient presentations and GP workloads as influencing the fluctuations in antibiotic prescribing. This was compounded by decreased engagement with, and priority of, AMS due to COVID-19-related urgent priorities. Re-engagement with AMS is needed, e.g., through reviving antibiotic prescribing feedback and targets/incentives. The pandemic disrupted, and required adaptations in, the usual ways of working and AMS. It is now important to identify opportunities, e.g., for re-organising ways of managing infections and AMS in the future.
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SciScore for 10.1101/2021.11.19.21266529: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics Consent: All participants provided informed consent verbally and written records of consent were made. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Experimental Models: Organisms/Strains Sentences Resources Data collection: Semi-structured interviews were conducted by telephone or video calls (depending on participants’ preferences) by an experienced qualitative, non-clinical researcher (AB). ABsuggested: RRID:BDSC_203)Software and Algorithms Sentences Resources All transcripts were uploaded to the qualitative data management software (NVivo, v.12, QRS International) and analysed thematically (taking an … SciScore for 10.1101/2021.11.19.21266529: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics Consent: All participants provided informed consent verbally and written records of consent were made. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Experimental Models: Organisms/Strains Sentences Resources Data collection: Semi-structured interviews were conducted by telephone or video calls (depending on participants’ preferences) by an experienced qualitative, non-clinical researcher (AB). ABsuggested: RRID:BDSC_203)Software and Algorithms Sentences Resources All transcripts were uploaded to the qualitative data management software (NVivo, v.12, QRS International) and analysed thematically (taking an inductive and realist/essentialist approach) (33). NVivosuggested: (NVivo, RRID:SCR_014802)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Limitations: Due to the rapid nature of the pandemic, we adapted and extended an existing study to explore the impact of COVID-19 on AMS. This led to some limitations. To ensure prompt recruitment, we used convenience sampling, including participants in the STEP-UP study (focused on implementation of AMS strategies) and others who expressed interest. Although the views of participants from the STEP-UP study and additional GPs did not seem to differ, participants’ views might have still differed from non-participants. Our aim was to capture change over time. However, most change took place at the start of the pandemic before we conducted the first round of interviews. Thus, the findings related to the initial pandemic phase rely on recollections and may be subject to a recall bias and reinterpretation. Most participants were from one Clinical Research Network area; GPs in other areas of England or countries might have reported different views and experiences. As with all qualitative studies, the findings are time- and context-specific. Implications: The main implications of this study relate to the need to resume AMS activities in primary care and adapt them to the post-pandemic models of care. Prioritizing AMS requires addressing other issues, such as finding ways to manage the increased workload or appropriate mix of remote and in-person consultations. Most immediately, CCGs need to resume AMS work to drive re-focusing on, and reinforcing, the importance of prudent antibioti...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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