An audit of antibiotic prescribing in primary care 2019-2020 in Dunmanway Primary Care Centre.

INTRODUCTION: Antibiotics are often the most common medication prescribed by general practitioners (GPs) and are often expected by patients despite campaigns such as Under the Weather. Antibiotic resistance is increasing in the community. The Health Service Executive (HSE) has issued 'Guidelines for Antimicrobial Prescribing in Primary Care in Ireland' aiming to optimise safe prescribing. This audit aims to analyse change in quality of prescribing after educational intervention. METHODS: GP prescribing patterns were analysed over a week in October 2019 and re-audited in February 2020. Anonymous questionnaires detailed demographics, condition and antibiotic details. Educational intervention included texts, information and review of current guidelines. Data were analysed on a password protected spreadsheet. The HSE Guidelines for Antimicrobial Prescribing in Primary Care were taken as reference standard. A standard of 90% compliance for choice of antibiotic and 70% compliance for dose and course was agreed. RESULTS: FindingsAuditRe-AuditNumber prescriptions4024Number delayed scripts4/40=10%1/24=4.2%Adult37/40=92.5%19/24=79.2%Child3/40=7.5%5/24=20.8%IndicationURTI22.50%25%LRTI10%4%Other RTI37.50%42%UTI20%29%Skin12.50%0%Gynaecological2.50%0%2+ Infections 5%0%Co-amoxiclav17.50%12.50%AdherenceChoice37/40=92.5%22/24=91.7%Dose28/39=71.8%17/24=70.8%Course28/40=70%12/24=50%Discussion: Excellent antibiotic choice and dose concordance with guidelines was noted, with both phases meeting the set standards. Suboptimal course compliance with guidelines occurred in the re-audit. Potential causes include concerns regarding resistance and patient factors not included. This audit included unequal number of prescriptions in each phase but are still of significance and addresses a clinically relevant topic.

A 'Farmer /Fisherperson and Allied Community Medical' - a quality-improvement template of care in primary care.

INTRODUCTION AND BACKGROUND: Ireland is an island known for its welcome, its warm people, green fields and beautiful coastline. A sizable proportion of the Irish population work in the farming, forestry and fishing industries, particularly in rural and coastal regions1. The broad farming and fisher people cohort have specific health and primary care needs2,3 and, as a result, I devised a template of care provision in primary care, to help guide the primary care team privileged to look after this unique group of people4. AIMS: To devise a template of proposed quality care or care considerations for members of the farming and fisher people community, which can be used in general practice, as part of the practice software system.To improve and ease delivery of high-quality primary care to the farming and fisher people in the community. METHODS: Personal reflection on my professional experience as a General Practitioner in rural and coastal communities from South West GP (General Practitioner) Training Scheme training to the current time, a lifetime of living in a rural location not too far from the sea, and the lessons I have learnt from the people of home, my local community, and the people I serve.Conversation with and feedback from a wise, retired farmer with thanks.Literature Review of the health concerns and needs of farmers and fisher people. RESULTS: Creation of a farmer/fisherperson medical quality-improvement template of care to support primary care delivery to these communities. DISCUSSION: A template of care provision for primary care to utilise if wished in caring for members of the fishing and farming communities to improve quality of care delivered, and which is accessible, user-friendly, and comprehensive.Plan to hopefully trial this template in primary care going forward, and audit the primary healthcare quality received by farmers and members of the fishing community, based on the parameters included in this quality improvement template.References1 Factsheet on Agriculture in Ireland 2016. https://igees.gov.ie/wp-content/uploads/2014/02/June-2016-Factsheet-Final.pdf [Retrieved 28 September 2022]2 Smyth B, Evans DS, Kelly A, Cullen L, O'Donovan D. The farming population in Ireland: mortality trends during the 'Celtic Tiger' years. European Journal of Public Health 2013; 23(1):50-55. https://doi.org/10.1093/eurpub/cks0173 Peninsula Team. Health and Safety in the Fishing Industry Aug 2018. https://www.peninsulagrouplimited.com/ie/blog/health-safety-in-the-fishing-industry [Accessed 14 September 2022]4 Kiely A. The Farmer and Fisherperson Primary Care Medical. Update Article. Forum Journal (ICGP). Accepted for Publication for Oct 2022 issue.