January's issue of Cardiff University News

TRANSFORMING HEALTHCARE
Cutting ‘unnecessary’
antibiotic use
A major University study which led to long-term reductions in the number of
antibiotic prescriptions by Welsh GPs could see ‘unnecessary’ prescriptions cut by
1.6M per year, if replicated across the UK.
The Stemming the Tide of
Antimicrobial Resistance or ‘STAR’
programme was designed and
implemented by experts from the
University’s School of Medicine’s
Institute of Primary Care and Public
Health and South East Wales Trials
Unit (SEWTU) to cut the number of
antibiotic prescriptions for common
conditions.
Professor Chris Butler
Led by Professor Chris Butler from
the School of Medicine, the trial
involved 68 practices across Wales
covering some 480,000 patients, and
offered GPs access to unique antibiotic
prescribing and resistance data derived
from their own practices and novel,
blended learning training in advanced
‘consulting skills’.
The learning tools, the result of more
than 15 years of work in infections
and communication sciences by
members of the Institute of Primary
Care and Public Health and SEWTU
team, are designed to enable GPs
to discuss treatment options more
effectively with their patients to
achieve evidence-based, shared and
acceptable treatment decisions.
The study gave GPs access to on-line
learning materials including videos,
and allowed them the flexibility to
learn and try out the new skills with
their patients at times that were
convenient to themselves.
“Antibiotic resistance remains one
of the most important public health
issues of our time, with antibiotic
prescribing driving up resistance,” said
Professor Butler.
“As most antibiotics are prescribed
in General Practice, safely reducing
the number of unnecessary
prescriptions is essential. The STAR
programme helped Welsh GPs gain
new skills derived from motivational
interviewing so they could achieve
evidence-based treatment while taking
patient perspectives into account.”
Professor Frank Dunstan, who led
the analysis, said: “Although the
percentage reduction in antibiotic
prescribing was fairly small, based on
national population estimates, if the
findings of this study were replicated
across the whole of Wales this would
imply a reduction of well over 78,000
dispensed systemic antibiotic items
per year, and if replicated across the
UK, this would mean a reduction of
roughly 1.6M dispensed systemic
antibiotic items per year.”
The study, published in the British
Medical Journal (BMJ), resulted in
fewer systemic antibiotics for all
indications dispensed for a whole
year for practices where GPs had
undergone STAR training.
Patients in the STAR practices did
not experience detectable increases in
complications, hospital admissions, reconsultation
rates, or costs associated
with fewer antibiotics.
Professor Dunstan has done
preliminary analyses of the effects of
the STAR Educational programme
over three years, and it seems the
positive effects are maintained over
the longer term as well.
Professor Butler adds: “STAR’s
achievement in reducing antibiotic
prescribing is significant because it
has shown signs of success where
other efforts such as public health
campaigns on antibiotic awareness
have failed: despite these campaigns,
antibiotic prescribing in the
community in the UK appears again to
be increasing.
“The STAR intervention goes to the
heart of the philosophical foundations
of general practice as it is based
on patient data from the practices
themselves, the best scientific
evidence, and effective communication
with patients.”
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