Work

Effectiveness of educational seminar and customized prescription order sets on antibiotic appropriateness for urinary tract infections in primary care

Year: 2025

Type: article

Abstract: • Educational seminar modestly improved antibiotic appropriateness and reduced selection errors for UTIs in primary care • Customizing prescription order sets in electronic medical records significantly increased appropriateness and reduced dosing errors • No sustained improvement in appropriateness observed after either intervention • Multifaceted, tailored strategies likely required for lasting antibiotic stewardship improvements Despite recent developments in national urinary tract infection (UTI) guidelines, primary care physicians have shown limited uptake. This study aims to evaluate the effectiveness of two antimicrobial stewardship interventions in improving antibiotic appropriateness for UTIs in primary care. A quasi-experimental study was conducted from March to December 2024 across seven public primary care clinics in Singapore. The study evaluated two interventions: (1) an educational seminar conducted for all clinics, and (2) Epic preference list customization of prescription order sets in one intervention clinic. Segmented regression analysis was used to assess overall changes in antibiotic appropriateness after educational seminar, while difference-in-differences analysis evaluated the specific impacts of preference list customization. 2,874 female patients with uncomplicated UTIs (median 59 years) were seen by 301 primary care physicians, with a mean 11.8 years (SD 9.5) of clinical experience. Educational seminar led to a significant increase in appropriateness rates (66.2% versus 61.3%, p=0.036) and reduction in wrong antibiotic selection (10.6% to 7.3%, p=0.018) across all clinics. Epic preference list customization demonstrated significantly higher appropriateness rates (85.9% versus 65.5%, p<0.001) and lower rates of inappropriate antibiotic frequency (9.8% versus 18.0%, p=0.01) and duration (0% versus 9.7%, p<0.001) in the intervention clinic. The interventions' sustained impact was limited, with no significant immediate or sustained improvement in antibiotic appropriateness demonstrated after the educational seminar or preference list customization. While preference list customization may be beneficial for maintaining antibiotic appropriateness, multifaceted approaches tailored to site-specific needs are necessary for lasting improvements in antibiotic stewardship.

Source: Journal of Global Antimicrobial Resistance

DOI: 10.1016/j.jgar.2025.11.004

Authors: Eunice Rui Ning Wong, Nicole Tham, Si Hui Low, Jun Cong Goh, Haresh Singaraju, Sky Wei Chee Koh

Institutions: National University Health System, National University Polyclinics, National University of Singapore

Language: English

Topic: Antibiotic Use and Resistance

Subfield: Applied Microbiology and Biotechnology

Field: Immunology and Microbiology

Domain: Life Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,890