A national quality incentive scheme to reduce antibiotic overuse in hospitals: Evaluation of perceptions and impact

J. Islam, Diane Ashiru Oredope, E. Budd, P. Howard, A. S. Walker, Susan Hopkins, M. J. Llewelyn*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)

Abstract

Background: In 2016/2017, a financially linked antibiotic prescribing quality improvement initiative Commissioning for Quality and Innovation (AMR-CQUIN) was introduced across acute hospitals in England. This aimed for > 1% reductions in DDDs/1000 admissions of total antibiotics, piperacillin/tazobactam and carbapenems compared with 2013/2014 and improved review of empirical antibiotic prescriptions. Objectives: To assess perceptions of staff leading antimicrobial stewardship activity regarding the AMR-CQUIN, the investments made by hospitals to achieve it and how these related to achieving reductions in antibiotic use. Methods: We invited antimicrobial stewardship leads at acute hospitals across England to complete a webbased survey. Antibiotic prescribing data were downloaded from the PHE Antimicrobial Resistance Local Indicators resource. Results: Responses were received from 116/155 (75%) acute hospitals. Owing to yearly increases in antibiotic use, most trusts needed to make > 5% reductions in antibiotic consumption to achieve the AMR-CQUIN goal of 1%reduction. Additional funding wasmade available at 23/113 (20%) trusts and, in 18 (78%), this was < 10%of the AMR-CQUIN value. Nationally, the annual trend for increased antibiotic use reversed in 2016/2017. In 2014/2015, year-on-year changeswere+3.7%(IQR-0.8%,+8.4%),+9.4%(+0.2%,+19.5%) and+5.8%(-6.2%,+18.2%) for total antibiotics, piperacillin/tazobactam and carbapenems, respectively, and +0.1% (-5.4%, +4.0%), -4.8% (-16.9%,+3.2%) and-8.0%(-20.2%,+4.0%) in 2016/2017. Hospitalswhere staff believed they could reduce antibioticuseweremore likely todo so (P < 0.001). Conclusions: Introducing the AMR-CQUIN was associated with a reduction in antibiotic use. For individual hospitals, achieving the AMR-CQUIN was associated with favourable perceptions of staff and not availability of funding.

Original languageEnglish
Pages (from-to)1708-1713
Number of pages6
JournalJournal of Antimicrobial Chemotherapy
Volume73
Issue number6
DOIs
Publication statusPublished - 1 Jun 2018

Bibliographical note

Funding Information:
We would like to thank Kieran Hand, Paul Wade and Stuart Brown for their feedback on the pilot survey. This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Reference Number RP-PG-0514-20015). A. S. W. and S. H. are supported by the NIHR Health Protection Research Unit (HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Oxford University in partnership with Public Health England (PHE) (grant HPRU-2012-10041). D. A.-O. and S. H. are affiliated with the NIHR HPRU in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London.

Funding Information:
This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Reference Number RP-PG-0514-20015). A. S. W. and S. H. are supported by the NIHR Health Protection Research Unit (HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Oxford University in partnership with Public Health England (PHE) (grant HPRU-2012-10041). D. A.-O. and S. H. are affiliated with the NIHR HPRU in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London.

Publisher Copyright:
© The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.

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