PrescQIPP

Reducing amoxicillin course length by adding a quality option to our ICB prescribing incentive scheme (2025)

Bernadette Baretto and Harshna Chhaya

Project summary

My colleague and I are part of the Coventry and Warwickshire AMR strategy group. We closely monitor antimicrobial use for the ICB as part of our role as Medicines Optimisation Pharmacists. One of the 16 National medicines Optimisation priorities for 2024/ 25 was reducing course length of antimicrobials and specifically reducing amoxicillin course length and increasing the proportion of 5 day courses as a proportion of total amoxicillin 500mg capsule prescription items.

When we checked our data at the end of 2023 and beginning of 2024, we found that our ICB was one of the highest ICBs nationally for prescribing greater than 5-day courses of amoxicillin. It was also an outlier in our region. We therefore decided to add this quality option as part of our Prescribing Incentive Scheme. The Prescribing Incentive Scheme was already costed so no added monies were required for the scheme.

We presented Educational Webinars for training of the staff groups using TARGET resources and included information on local resistance patterns to emphasise the messages, focusing mainly on common primary care infections. We also used Pharmacy First info to leverage the messages. The Webinars were supported by Consultant Microbiologists from our local Trust who provided clinical scenarios and we allowed ample time at the end so that live questions could be answered. This collaborative approach helped to deliver the message that reducing antimicrobial course length appropriately was not only safe for the patient to treat infections but could also reduce adverse effects for the patient, as well as address the ongoing issues of antimicrobial resistance.

Although the initial national ambition was set at around 75% initially, we made a more achievable target of 50% increase from their baseline for the individual practices.

A consistent reduction in percentage of amoxicillin courses greater than 5 days was seen after the prescribing incentive scheme was launched in April 2024 to date.