Antibiotics are frequently used in the ambulatory care environment. Inappropriate use not only can lead to subopti-mal clinical and economic outcomes, but may also lead to the emergence of resistance . It is important to promote the appropriate use of antibiotics because this may delay and prevent the emergence of antibiotic resistance . Development of strategies aimed at reducing inappropriate antibiotic use, in particular, the instituting practice guidelines and policies has been recommended. An important component of these programs is the education of health care providers.
In the Canadian Armed Forces, physician assistants are trained to provide basic medical services in areas where physicians may not be available. Their work is particularly valuable in operational theatres, such as on ships and during missions abroad. The scope of the physician assistant responsibilities includes evaluating a medical condition and prescribing drug therapy. Prescribing is, however, limited to a predefined list of Canadian medications. Formal internal training programs in the Canadian Armed Forces are provided to ensure that physician assistants remain competent. The other group of prescribers is composed of formally trained physicians who have chosen to practise in the military environment. Both general practitioners as well as specialists are actively practising in the Canadian Armed Forces.
The primary objective of the present drug use evaluation (DUE) was to evaluate prescribing among military practitioners and to assess the degree of adherence to two sets of guidelines for the treatment of common infections. Prescribers were divided in three types: physician assistants, general practitioners and specialists. For the purpose of this project, prescribers were stationed in either Canadian naval bases or on Her Majesty’s Canadian ships. Both the East (Halifax) and west (Esquimalt) coasts bases were targetted for this project. The secondary objective was to identify infections most commonly treated in the Canadian Forces ambulatory care services and to determine for which infections the treatment was most frequently at variance with the guidelines. Results of this evaluation will be used to improve continuing education programs for military prescribers as well as to develop intervention programs aimed at optimizing ambulatory use of antibiotics in the Canadian Armed Forces.