• Nuala O'Connor, Roisin Breen, Mícheál Carton, Ina Mc Grath, Norma Deasy, Claire Collins, and Akke Vellinga.
• Elmwood Medical Practice, Frankfield, Cork, Ireland.
• Eur J Gen Pract. 2020 Dec 1; 26 (1): 119-124.

BackgroundAntibiotic resistance is a threat to our health and health systems. Up to 70% of antibiotics are prescribed in general practice. In Ireland, Out-of-hours (OOH) services are mostly provided by co-operatives of GPs and the 11 main OOH centres cover up to 90% of the population. More than 80% of GPs are involved in OOH care in their area, which provides an opportunity to deliver education and awareness through this centralised system.ObjectivesTo analyse the change in the quality of antibiotic prescribing after the introduction of an educational intervention categorising antibiotics into a red (avoid) and green (preferred) panel.MethodsEducational information for the GP was developed based on the national prescribing guidelines. A particular focus was to reduce co-amoxyclav prescribing. An electronic pop-up message to record whether an antibiotic was prescribed, was displayed at the end of each consultation in the patient management software of the OOH-centre, after the decision of prescribing was made. Antibiotic prescribing was compared for a 13-week period (week 47-week 7) in 2016/2017 with 2017/2018.ResultsPre-intervention prescribing of red antibiotics was 44% which reduced to 17% after the intervention. The mean percentage of co-amoxyclav, the most prescribed non-firstline prescription, was 33% of all antibiotic prescriptions which dropped to 10%.ConclusionOur intervention implemented in the OOH GP service categorised antibiotics into red prescriptions and green (firstline) prescriptions, which was recorded through an electronic pop-up message, resulted in an absolute reduction of 27% in red prescriptions and more than 23% in co-amoxyclav prescriptions.

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