*Author contact: m.gharbi@imperial.ac.uk. Acknowledgements: BSAC the British Society for Antimicrobial Chemotherapy and NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London and NIHR Imperial Biomedical Research Centre A cross-sectional study for optimizing antimicrobial prescribing practice among junior doctors in acute care settings in England (APED study) Myriam Gharbi 1* , Luke SP Moore 1,2 , Elpiniki Spanoudaki 1 , Enrique Castro-Sánchez 1 , Alison H Holmes 1,2 , Lydia N Drumright 1,3 1 NIHR Health Protection Research Unit Antimicrobial Resistance and Healthcare Associated Infection, Imperial College London, UK, 2 Imperial College Healthcare NHS Trust, London, UK, 3 Department of Medicine, University of Cambridge, UK Background Appropriate antimicrobial prescribing is essential for optimal clinical care, patient safety and minimisation of resistance and healthcare- associated infections. Yet up to 50% of antimicrobial prescriptions are thought to be sub-optimal in acute-care settings. As prescribing is primarily the role of junior doctors in England, there is a critical need to better understand their current practice, as well as gaps in knowledge and training. Objective To identify gaps in knowledge and to understand junior doctors’ perceptions, attitudes and behaviour in order to inform suitable improvements in post-graduate curricula and continuing professional development Methods - Cross-sectional multi-centre study April 2014 - Population: qualified doctors in training in the Health Education North West London region - 42-item questionnaire exploring antimicrobial prescribing practices, previous education and learning preferences - Exploration of associations between demographics, training interests, attitudes and i- knowledge to antibiotic prescribing and ii- confidence in prescribing using univariate / multivariate analyses Image 2 Image 1 Results: prescribing practice - 19.9% don’t feel confident in writing an antimicrobial prescription Table 3: Multiple Logistic regression analysis examining associated factors of feeling confident prescribing antimicrobials as a junior doctor Discussion - Confidence in antimicrobial prescribing was improved by greater support (from seniors and specialists) and more certainty in the diagnosis - However, difficulty in accessing help during the nights, week-ends and holidays (67.2%) but also surprisingly during standard working hours (7.8%) - Confidence decreased with lack of knowledge highlighting the need for focussed training Limitations: - The sample predominantly captured the two most junior levels of doctors in training - The study was limited to a West London hospital network where antimicrobial stewardship is ensconced across the healthcare teams, possibly influencing responses - We described the self-reported behaviour of junior doctors and their perception on antimicrobial prescribing practice. An observational study assessing knowledge and behaviour should be conducted to validate results References 1. Davey P, Brown E, Charani E, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev 2013; 4:CD003543. 2. Pulcini C, Williams F, Molinari N, et al. Junior doctors' knowledge and perceptions of antibiotic resistance and prescribing: a survey in France and Scotland. Clin Microbiol Infect 2011; 17:80-87. 3. Navarro-San Francisco C, Del Toro MD, Cobo J, et al. Knowledge and perceptions of junior and senior Spanish resident doctors about antibiotic use and resistance: results of a multicenter survey. Enferm Infecc Microbiol Clin 2013; 31:199-204. Results: training needs - 74.1% of respondents reported wanting further antimicrobial prescribing education - Only a small percentage found current teaching sessions effective (5- 13%) - The majority (41.9-46.3%) learned better through self-education & reading policies - A preference was exhibited for training to be delivered via Problem-Based Learning (39.1%) through a series of one hour seminars (39.0%) or half day courses (31.9%) - The content of the course should mainly cover the following themes: “the principles of antimicrobial prescribing” (63.8%) and “the principles of clinical review of infection and therapy” (56.7%) Figure 2: Characteristics of additional antimicrobial prescribing training that junior doctors would like to receive Figure 3: Desirable antimicrobial prescribing topics for junior doctors to receive training in Conclusions - There is a need for focussed, learner-centred, mixed method approaches to antimicrobial prescribing education among junior doctors - There is a need for education to be ensconced within an organisational structure which also provides appropriate infection specialist, decision making, and diagnostic support - Our study will inform the development of an educational tool that interactively delivers knowledge, shape behaviours and attitudes for antimicrobial prescribing EP221 - 140 completed questionnaires (participation rate: 83.8%) - 34.4% reported prescribing primarily unsupervised even in their 1st year post-qualification - Only 36.9% considered antimicrobial resistance when prescribing - Only 29.0% considered de-escalation (i.e. switch from intravenous to oral therapy) as recommended within 24 hours Figure 1: Factors influencing confidence about antimicrobial prescribing in junior doctors Table 2: Comparison of prescribing practices and knowledge between 1 st , 2 nd and 3 rd year postgraduate juniors doctors in London Table 1: Demographic and education characteristics of junior doctor respondents Table 4: Comparison of the prescribing needs between 1st, 2nd and 3rd year postgraduate juniors doctors in London View publication stats View publication stats