The situation in Ireland is very similar to the UK in terms of the pressure on GPs, the increased patient demand for consultations and the requirement to fit more patient appointments into the day, stated Dr Noonan. However, the Out of Hours structure in Ireland is very different and sees all patients from 6pm to 8am on weekdays and at weekends. There was a directive issued earlier this year, advising doctors to prescribe antibiotics for any patient who had either already recently seen their GP, or who seemed to be particularly adamant for an antibiotic prescription. The motivation for this was to increase patient satisfaction and reduce litigation. Expressing frustration, Dr Noonan explained that this is likely to negatively affect the relationship between the patient and their regular doctor and increase the overall number of antibiotic prescriptions.
There has been a dramatic increase in the number of consultations over the last two to three years, largely because all children under the age of six are now seen for free. Consequently, this has also increased the usage of antibiotics in that age group. These changes in practice are surprising, given that Ireland already has an AMR Stewardship program. The website antibioticprescribing.ie gives guidelines for the correct treatment of specific bacterial infections that doctors are supposed to reference before they prescribe an antibiotic.
From a patient perspective, the patient website undertheweather.ie provides advice on how to manage self-limiting conditions including RTI and provides patients with realistic expectations of symptom duration. Efforts to educate patients on how to use antibiotics continue and is accompanied by advice on medical tourism to dissuade patients from buying antibiotics abroad at a discounted price and bringing them home for later use.
Despite having an AMR programme in operation in Ireland, there was a directive issued in one of the largest out of hours co-ops that essentially said in order to increase patient satisfaction and reduce complaints, we would recommend that all doctors prescribe antibiotics for patients who have already been seen by their own doctor
Dr Laura Noonan