Abstract / Summary
Background: The WHO AWaRe (Access/Watch/Reserve) book gives detailed guidance on the optimal use of antibiotics across primary care and hospital settings aiming to improve the quality of antibiotic use. Objectives: To develop model sets of appropriate and feasible quality indicators (QIs) based on the WHO AWaRe system, that are widely implementable across primary care, hospital, and general healthcare system settings to support optimal antibiotic use. Methods: Indicators from a scoping review were revised to focus on clinical infections in the AWaRe book. They were assessed using two rounds each of the Global Delphi Technique and RAND/UCLA Appropriateness Method evaluating appropriateness and feasibility at national and global levels respectively. In Round 1 of each method, panellists rated clarity and suggested revisions or new indicators. Round 2 results are reported. The indicators were then reviewed to create a priority list based on WHO book antibiotic choice recommendations, burden of disease, and positive measurement. Results: The AWaRe QIs covered common primary and hospital infections listed in the AWaRe book and general patient and population level indicators. There were 102 quality indicators (Primary Care: 46; Hospital: 39; General: 17) included in Round 2 of the Delphi Technique and 136 indicators (Primary Care: 56; Hospital: 60; General: 20) in Round 2 of the RAND/UCLA method.. The prioritisation process resulted in 20 core indicators (Primary Care: 10, Hospital: 8, General: 2). Conclusion: AWaRe quality indicators have been derived to support optimal antibiotic use, and inform stewardship programs.