title: Enhancing the quality of antibiotic prescribing in primary care: qualitative evaluation of a blended learning intervention.
abstract: BACKGROUND
  The Stemming the Tide of Antibiotic Resistance (STAR) Educational Program aims to enhance the quality of antibiotic prescribing and raise awareness about antibiotic resistance among general medical practitioners. It consists of a seven part, theory-based blended learning program that includes online reflection on clinicians' own practice, presentation of research evidence and guidelines, a practice-based seminar focusing on participants' own antibiotic prescribing and resistance rates in urine samples sent from their practice, communication skills training using videos of simulated patients in routine surgeries, and participation in a web forum. Effectiveness was evaluated in a randomised controlled trial in which 244 GPs and Nurse Practitioners and 68 general practices participated. This paper reports part of the process evaluation of that trial.
  
  
  METHODS
  Semi-structured, digitally recorded, and transcribed telephone interviews with 31 purposively sampled trial participants analysed using thematic content analysis.
  
  
  RESULTS
  The majority of participants reported increased awareness of antibiotic resistance, greater self-confidence in reducing antibiotic prescribing and at least some change in consultation style and antibiotic prescribing behaviour. Reported practical changes included adopting a practice-wide policy of antibiotic prescription reduction. Many GPs also reported increased insight into patients' expectations, ultimately contributing to improved doctor-patient rapport. The components of the intervention put forward as having the greatest influence on changing clinician behaviour were the up-to-date research evidence resources, simple and effective communication skills presented in on-line videos, and presentation of the practice's own antibiotic prescribing levels combined with an overview of local resistance data.
  
  
  CONCLUSIONS
  Participants regarded this complex blended learning intervention acceptable and feasible, and reported wide-ranging, positive changes in attitudes and clinical practice as a result of participating in the STAR Educational Program.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN63355948.
authors.affiliation: South East Wales Trials Unit, School of Medicine, Cardiff University, Cardiff, UK. BekkersM@cardiff.ac.uk
authors.forename: Marie-Jet
authors.initials: MJ
authors.lastname: Bekkers
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Simpson
authors.forename: Frank
authors.initials: F
authors.lastname: Dunstan
authors.forename: Kerry
authors.initials: K
authors.lastname: Hood
authors.forename: Monika
authors.initials: M
authors.lastname: Hare
authors.forename: John
authors.initials: J
authors.lastname: Evans
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Butler
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents; D002983:Clinical Competence; D003194:Computer-Assisted Instruction; D011307:Drug Prescriptions / Q000592:standards*; D004352:Drug Resistance, Microbial; D004502:Education, Medical, Continuing / Q000379:methods*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000193:education / Q000523:psychology; D010821:Physicians, Family / Q000193:education / Q000523:psychology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D011320:Primary Health Care / Q000379:methods / Q000592:standards*; D011785:Quality Assurance, Health Care
chemical_list: D000900:Anti-Bacterial Agents
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