Impact of the COVID-19 Pandemic on Community Antibiotic Prescribing and Stewardship: A Qualitative Interview Study with General Practitioners in England
Aleksandra J. Borek,
Katherine Maitland,
Monsey McLeod,
Anne Campbell,
Benedict Hayhoe,
Christopher C. Butler,
Liz Morrell,
Laurence S. J. Roope,
Alison Holmes,
Ann Sarah Walker,
Sarah Tonkin-Crine,
on behalf of the STEP-UP Study Team
Affiliations
Aleksandra J. Borek
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
Katherine Maitland
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
Monsey McLeod
National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London W12 0NN, UK
Anne Campbell
National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London W12 0NN, UK
Benedict Hayhoe
Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
Christopher C. Butler
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
Liz Morrell
Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
Laurence S. J. Roope
Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
Alison Holmes
National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London W12 0NN, UK
Ann Sarah Walker
NIHR Oxford Biomedical Research Centre, Oxford OX3 9DU, UK
Sarah Tonkin-Crine
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
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.
