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A new module was delivered to an international group of health professionals on ‘Antimicrobial stewardship (AMS) in primary care: a behaviour change approach’. This is an advanced, core module delivered as part of the training for the AMS Certificate (2022-24). The certificate is offered by the European Society for Clinical Microbiology and Infectious Diseases (ESCMID), Europe’s leading non-profit organisation with a mission to improve the diagnosis, treatment and prevention of infection-related diseases.

AMS is a term used to capture a broad range of efforts, approaches and strategies that aim to optimise how antibiotics are prescribed by clinicians and used by patients. Improving antibiotic use involves avoiding unnecessary use (e.g., for infections that don’t benefit from antibiotics) or inappropriate use (e.g., incorrect type or dose). It is critical to mitigate against the growing risks of antimicrobial resistance (AMR), a global public health priority, sometimes referred to as the ‘silent’ or ‘overlooked’ pandemic.

Developing and delivering this new module is important for two main reasons.

First, primary care is often overlooked in the training of health professionals in AMS. Most health professionals learn about AMS as part of their clinical roles in secondary care and public health, for example, as microbiologists, pharmacists, specialist doctors and nurses. Yet, most antibiotics are prescribed in primary care and many of the diverse AMS interventions have been developed and tested in primary care. This means that other health professionals from different settings can benefit from learning about the progress made in AMS in primary care, particularly focussing on the influences on antibiotic prescribing and interventions that improve antibiotic use.

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Second, behavioural and implementation sciences have an important role in AMS. Most health professionals at the forefront of AMS are trained in microbiological aspects of AMR and the clinical and pharmacological aspects of antibiotic use. Yet, designing and implementing strategies to optimise antibiotic use depends largely on changing the behaviours of clinicians and clinical teams – for example, reviewing and changing current practices such as adopting new guidelines. Drawing on the principles of behavioural and implementation sciences can be valuable in AMS: it can help identify the behaviours that need to be changed and what influences them, and systematically develop and evaluate strategies to facilitate change in practice.

The Department has an established expertise in the topics of acute infections, AMS and behavioural and implementation sciences. Delivering the module further promotes the Department’s role in improving infection management and AMS by promoting systematic approaches to behaviour change and implementation.

The module was delivered over two days at the end of March 2023 by Oliver van Hecke, Marta Wanat, Aleksandra Borek, Sarah Tonkin-Crine and Gail Hayward from the Infections & Acute Care and Behaviour and Qualitative Infections groups. It covered the role and importance of primary care in AMS, evidence on influences and interventions related to AMS and antibiotic prescribing in primary care, in-depth sessions on effective AMS interventions, and a behavioural approach to designing, evaluating and implementing AMS interventions. The feedback was overwhelmingly positive. We already look forward to delivering the module again next year to the new cohort.


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