Background and aims

This project aims to examine the effectiveness and implementation process of population-level interventions to reduce inappropriate antibiotic use in Canada and globally. Specific objectives include:

1. To conduct a systematic review at the global level to evaluate the effectiveness of population-level interventions in reducing inappropriate antibiotic use in health care and community settings;
2. To explore Canadian and global experiences of implementing population-level interventions and identify implementation facilitators and barriers in primary care settings using a qualitative case study approach;
3. To propose policy recommendations and road maps for developing population-level interventions to reduce inappropriate antibiotic use in primary care settings for Canada.

Project phases

Progress

• Initial preparation for starting Phase I of the project is ongoing.

Research Team Members

Xiaolin Wei, Donald Sheppard, Raja Abbas, Sara Allin, Karen Born, Victoria Haldane, Virginia Hernandez Santiago, Shaheer Khan, Olivia Magwood, Michael Kidd, Lee Nelson, Myles Leslie, John Mclaughlin, Frank Sullivan, Qiang Sun, Peizhong Peter Wang, Shishi Wu, Shahzad Ali Khan

Sponsors and Funding Agencies

Canadian Institutes of Health Research (CIHR)

Project Contact

Shishi Wu

shishi.wu@utoronto.ca

Background and aims

This project aims 1) to bridge resources and knowhows from both teams to explore how to employ innovative diagnostic tools, such as C creation Protein (CRP), in primary care to improve appropriate use of antibiotics in China and other LMICs, and 2) to promote interdisciplinary learning among students and faculties of our two universities. We will develop and pilot interventions based on CRP using implementation science frameworks. Our results will inform future joint-research projects to inform antibiotic regulation policies in China and other LMICs for better antimicrobial stewardship in primary care and community settings.

Our research activities include the following:

Phase I: Contextual analysis. Employing implementation science frameworks to explore possible interventions and implementation strategies to promote the use of new diagnostic technologies in primary care and communities.

Phase II: Design of the interventions and piloting. We will employ a collective-making approach to develop AMR interventions and conduct the pilots in Hubei Province, China. We will evaluate the interventions with the adapted RE-AIM framework in implementation science.

Phase III: Organizing workshops on implementation science and antimicrobial stewardship in primary care and communities. Online discussions and field visits will be included during the project to improve antimicrobial stewardship.

Progress

We are now in Phase I conducting the contextual analysis.

Research Team Members

University of Toronto Team

Xiaolin Wei, Xu Wei,Erijia Ge,Shishi Wu, Raja Abbas, Quanfang Dong, Zhitong Zhang, Hongyu Huang

Huazhong University of Science and Technology Team

Xiaoxv Yin, Na Tang, Qinnan Li, Jinxi Li, Rui Chen

Sponsors and Funding Agencies

UofT-HUST JOINT SEED FUND

Project Cotact

Xiaoxv Yin
yxx@hust.edu.cn

Background and Aims

Antibiotic stewardship program in primary care facilities to reduce inappropriate antibiotic prescriptions for acute respiratory tract infections: a clustered randomized controlled trial and follow-up study in rural China.

Antibiotic resistance is accelerated by the misuse and overuse of antibiotics, as well as poor infection prevention and control. In China, the Chinese Ministry of Health (MOH) has issued policies to regulate the use of antibiotics; however, these policies have not been effectively enforced in rural primary care facilities. The misuse of antibiotics continues to be a challenge in rural areas where health workers often lack the training and medical knowledge to prescribe antibiotics appropriately and government policies are not actively followed.

Shaoguan is one of the poorest cities in Guangdong province, China. Primary care in rural areas is provided by public township hospitals and private village clinics. Each township hospital covers 50,000 to 100,000 people and typically has less than 100 beds and 20-40 family physicians. We aim to improve the current practice of antibiotic prescribing by establishing an antibiotic stewardship program in primary care facilities in Shaoguan for family physicians and patients and their caregivers. The intervention strategies include training sessions, peer-review meetings, improving electronic medical records, and a smart phone application to facilitate peer-review meeting and health education.

This study is a parallel-group, cluster-randomised, controlled, superiority trial with blinded outcome evaluation but unblinded treatment, and one of the first trials to evaluate the effectiveness of an antibiotic stewardship program in primary care setting in a low-and middle-income country (LMIC).

Progress

• The trial has been completed by February 2021 and data analysis is on-going
• Long-term follow-up is on-going

Updated March 11th, 2022.

Publications

An antibiotic stewardship programme to reduce inappropriate antibiotic prescribing for acute respiratory infections in rural Chinese primary care facilities: study protocol for a clustered randomised controlled trial.

Research Team Members

Xiaolin Wei

Nanshan Zhong

Chao Zhuo

Joseph Paul Hicks

Sponsors and Funding Agencies

China Primary Care Foundation

Project Contact

Zhitong Zhang zhitong.zhang@utoronto.ca