A recent rapid assessment of antimicrobial stewardship in Kosovo found that 73.9% of patients with tonsillopharyngitis received antibiotics without microbiological confirmation of a bacterial infection. Primary care is the first point of contact for 89% of people, so prescribing decisions there carry the most weight.
A new study protocol in BMJ Open explains how the National Institute of Public Health of Kosovo and partners will measure two things: the effect of a primary care antimicrobial stewardship programme, and what that programme costs to deliver.
The approach:
- 12 main family medicine centres take part. Six implement the programme and six act as comparison sites.
- Antibiotic use for upper respiratory tract infections is tracked in defined daily doses per 1,000 patient visits, before, during and after implementation.
- Implementation costs are recorded across the design, implementation and maintenance phases. Central costs are separated from site-specific costs to show what scale-up would require.
There is also a practical lesson from the pilot. Researchers’ presence at facilities changed prescribing behaviour straight away. To keep the baseline accurate, the team switched to routine prescription records.
Why it matters:
Economic evidence on stewardship in low- and middle-income settings is still limited. Decision-makers need to know whether a programme works, and also what it takes to sustain and expand it. This study will give Kosovo’s health authorities that evidence.
The work is part of an ICARS-supported project on antimicrobial stewardship in Kosovo. It combines prescriber training, Rapid Strep Testing, point prevalence surveys and clinical audits.
