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Cronberg O, Tyrstrup M, Ekblom K, Hedin K. Factors influencing antibiotic prescribing for respiratory tract infections in primary care - a comparison of physicians with different antibiotic prescribing rates. Scand J Prim Health Care 2024; 42:424-434. [PMID: 38625913 PMCID: PMC11332303 DOI: 10.1080/02813432.2024.2332757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/13/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND There has been a notable decrease in antibiotic prescribing in the last thirty years in Sweden. Little is known about factors influencing antibiotic prescribing over several years. OBJECTIVE To compare primary care physicians who, over time, reduced their antibiotic prescribing for respiratory tract infections with those who remained either high or low prescribers regarding potentially influencing factors. DESIGN AND SETTING A register-based study including all RTI visits in primary care in Region Kronoberg, Sweden 2006-2014. The data were divided into three 3-year periods. SUBJECTS The data comprised all physicians who had diagnosed at least one RTI for each of the three-year periods. The antibiotic prescribing rate adjusted for the patients' sex and age group was calculated for each physician and period, and based on the change between the first and the third period, the physicians were divided into three prescriber groups: The High Prescribing Group, the Decreasing Prescribing Group, and the Low Prescribing Group. MAIN OUTCOME MEASURES For the three prescriber groups, we compared factors influencing antibiotic prescribing such as the characteristics of the physicians, their use of point-of-care tests, their choice of diagnoses, and whether the patients returned and received antibiotics. RESULTS The High Prescribing Group ordered more point-of-care tests, registered more potential bacterial diagnoses, prescribed antibiotics at lower C-reactive protein levels, and prescribed antibiotics more often despite negative group A Streptococci test than in the Low Prescribing Group. The Decreasing Prescribing Group was between the High Prescribing Group and the Low Prescribing Group regarding these variables. The lower prescription rate in the Low Prescribing Group did not result in more return visits or new antibiotic prescriptions within 30 days. CONCLUSION Point-of-care testing and its interpretation differed between the prescriber groups. Focus on interpreting point-of-care test results could be a way forward in antibiotic stewardship.
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Affiliation(s)
- Olof Cronberg
- Växjöhälsan Primary Healthcare Center, Växjö, Sweden
- Department of Research and Development, Region Kronoberg, Växjö, Sweden
- Department of Clinical Sciences in Malmö, Family Medicine, Lund University, Malmö, Sweden
| | - Mia Tyrstrup
- Department of Clinical Sciences in Malmö, Family Medicine, Lund University, Malmö, Sweden
- Lundbergsgatan Primary Health Care Centre, Malmö, Sweden
| | - Kim Ekblom
- Department of Research and Development, Region Kronoberg, Växjö, Sweden
- Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden
| | - Katarina Hedin
- Department of Clinical Sciences in Malmö, Family Medicine, Lund University, Malmö, Sweden
- Futurum, Region Jönköping County, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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2
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Baillie EJ, Merlo G, Van Driel ML, Magin PJ, Hall L. Early-career general practitioners' antibiotic prescribing for acute infections: a systematic review. J Antimicrob Chemother 2024; 79:512-525. [PMID: 38252922 PMCID: PMC10904722 DOI: 10.1093/jac/dkae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Antimicrobial resistance is a worldwide threat, exacerbated by inappropriate prescribing. Most antibiotic prescribing occurs in primary care. Early-career GPs are important for the future of antibiotic prescribing and curbing antimicrobial resistance. OBJECTIVES To determine antibiotic prescribing patterns by early-career GPs for common acute infections. METHODS A systematic literature search was conducted using PubMed, Embase and Scopus. Two authors independently screened abstracts and full texts for inclusion. Primary outcomes were antibiotic prescribing rates for common acute infections by GPs with experience of 10 years or less. Secondary outcomes were any associations between working experience and antibiotic prescribing. RESULTS Of 1483 records retrieved, we identified 41 relevant studies. Early-career GPs were less likely to prescribe antibiotics compared with their more experienced colleagues (OR range 0.23-0.67). Their antibiotic prescribing rates for 'any respiratory condition' ranged from 14.6% to 52%, and for upper respiratory tract infections from 13.5% to 33%. Prescribing for acute bronchitis varied by country, from 15.9% in Sweden to 26% in the USA and 63%-73% in Australia. Condition-specific data for all other included acute infections, such as sinusitis and acute otitis media, were limited to the Australian context. CONCLUSIONS Early-career GPs prescribe fewer antibiotics than later-career GPs. However, there are still significant improvements to be made for common acute conditions, as their prescribing is higher than recommended benchmarks. Addressing antimicrobial resistance requires an ongoing worldwide effort and early-career GPs should be the target for long-term change.
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Affiliation(s)
- Emma J Baillie
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Greg Merlo
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Mieke L Van Driel
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Parker J Magin
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- GP Training Research Department, Royal Australian College of General Practitioners, Callaghan, NSW, Australia
| | - Lisa Hall
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
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Carlsson S, Hedin K, Cronberg O, Moberg A. Antibiotic Treatment for Lower Respiratory Tract Infections in Primary Care: A Register-Based Study Examining the Role of Radiographic Imaging. Antibiotics (Basel) 2023; 12:1165. [PMID: 37508261 PMCID: PMC10376247 DOI: 10.3390/antibiotics12071165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
When imaging (i.e., chest-x-ray or computed tomography) is used to differentiate between acute bronchitis and pneumonia, many patients are being prescribed antibiotics despite the absence of radiographic pneumonia signs. This study of lower respiratory tract infections (LRTIs) with negative chest imaging compares cases where antibiotics were prescribed and not prescribed to find characteristics that could explain the prescription. Data were extracted from the regional electronic medical record system in Kronoberg County, Sweden, for patients aged 18-79 years diagnosed with acute bronchitis or pneumonia and who had any chest radiologic imaging between 2007-2014. Of 696 cases without evidence of pneumonia on imaging, 55% were prescribed antibiotics. Age, sex, and co-morbidity did not differ between those with or without antibiotics. The median level of C-reactive protein was low in both groups but differed significantly (21 vs. 10 mg/L; p < 0.001). Resident physicians prescribed antibiotics more frequently than interns or specialists (p < 0.001). It is unclear what features prompted the antibiotic prescribing in those with negative imaging indicating overuse of antibiotics for LRTIs.
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Affiliation(s)
- Sara Carlsson
- Department of Infection Disease and Control, Region Östergötland, 58185 Linköping, Sweden
| | - Katarina Hedin
- Futurum-The Academy for Health and Care, Region Jönköping County, 55185 Jönköping, Sweden
- Department of Clinical Sciences in Malmö, Family Medicine, Lund University, 20502 Malmö, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, 58183 Linköping, Sweden
| | - Olof Cronberg
- Department of Clinical Sciences in Malmö, Family Medicine, Lund University, 20502 Malmö, Sweden
- Växjöhälsan Primary Healthcare Center and Department of Research and Development, Region Kronoberg, 35112 Växjö, Sweden
| | - Anna Moberg
- Department of Health, Medicine and Caring Sciences, Linköping University, 58183 Linköping, Sweden
- Kärna Primary Healthcare Center, Region Östergötland, 58662 Linköping, Sweden
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Skow M, Fossum GH, Høye S, Straand J, Emilsson L, Brænd AM. Antibiotic treatment of respiratory tract infections in adults in Norwegian general practice. JAC Antimicrob Resist 2023; 5:dlac135. [PMID: 36632357 PMCID: PMC9825809 DOI: 10.1093/jacamr/dlac135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/11/2022] [Indexed: 01/09/2023] Open
Abstract
Objectives To analyse the prevalence of respiratory tract infection (RTI) episodes with and without antibiotic prescriptions in adult patients in Norwegian general practice during the period 2012-2019. Methods Observational study linking data from the Norwegian Control and Payment for Health Reimbursements Database and the Norwegian Prescription Database. Episodes of acute RTIs in patients aged 18 years or older were identified and linked to antibiotic prescriptions dispensed within 7 days after diagnosis. We analysed annual infection rates and antibiotic prescription rates and antibiotics prescribed for the different RTI conditions. Results RTI episode rate per 1000 inhabitants was 312 in 2012 and 277 in 2019, but showed no linear trend of change during the study period (P = 0.205). Antibiotic prescription rate decreased from 37% of RTI episodes in 2012 to 23% in 2019 (P < 0.001). The reduction in prescribing was most pronounced for episodes coded with ICPC-2 symptom diagnoses, as well as upper RTIs, influenza, acute bronchitis and sinusitis. Prescriptions for phenoxymethylpenicillin decreased from 178 746 in 2012 to 143 095 in 2019, but increased as proportion of total antibiotic prescriptions from 40% in 2012 to 53% in 2019 (P < 0.001). Conclusions This study demonstrates stable RTI episode rates and reduced antibiotic prescription rates for RTIs for adults in Norwegian general practice 2012-2019. We also observed a shift towards relatively more use of phenoxymethylpenicillin and less broad-spectrum antibiotics. These changes are in line with the aims of the Norwegian strategy against antibiotic resistance.
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Affiliation(s)
| | - Guro H Fossum
- Department of General Practice, The Antibiotic Centre for Primary Care, Institute of Health and Society, University of Oslo, Oslo, Norway,Department of General Practice, General Practice Research Unit (AFE), Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Sigurd Høye
- Department of General Practice, The Antibiotic Centre for Primary Care, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Jørund Straand
- Department of General Practice, General Practice Research Unit (AFE), Institute of Health and Society, University of Oslo, Oslo, Norway
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Huang Y, Wei WI, Correia DF, Ma BHM, Tang A, Yeoh EK, Wong SYS, Ip M, Kwok KO. Antibiotic use for respiratory tract infections among older adults living in long-term care facilities: a systematic review and meta-analysis. J Hosp Infect 2023; 131:107-121. [PMID: 36202187 DOI: 10.1016/j.jhin.2022.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/22/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Antibiotics are commonly prescribed for respiratory tract infections (RTIs) among older adults in long-term care facilities (LTCFs), and this contributes to the emergence of antimicrobial resistance. The objective of this study was to determine the antibiotic prescribing rate for RTIs among LTCF residents, and to analyse the antibiotic consumption patterns with the AwaRe monitoring tool, developed by the World Health Organization. METHODS MEDLINE, EMBASE and CINAHL were searched from inception to March 2022. Original articles reporting antibiotic use for RTIs in LTCFs were included in this review. Study quality was assessed using the Joanna Briggs Institute's Critical Appraisal Checklist for Prevalence Data. A random-effects meta-analysis was employed to calculate the pooled estimates. Subgroup analysis was conducted by type of RTI, country, and study start year. RESULTS In total, 47 articles consisting of 50 studies were included. The antibiotic prescribing rate ranged from 21.5% to 100% (pooled estimate 69.8%, 95% confidence interval 55.2-82.6%). The antibiotic prescribing rate for lower respiratory tract infections (LRTIs) was higher than the rates for viral and general RTIs. Compared with Italy, France and the USA, the Netherlands had lower antibiotic use for LRTIs. A proportion of viral RTIs were treated with antibiotics, and all the antibiotics were from the Watch group. Use of antibiotics in the Access group was higher in the Netherlands, Norway, Switzerland and Slovenia compared with the USA and Australia. CONCLUSION The antibiotic prescribing rate for RTIs in LTCFs was high, and AWaRe antibiotic use patterns varied by type of RTI and country. Improving antibiotic use may require coordination efforts.
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Affiliation(s)
- Y Huang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - W I Wei
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - D F Correia
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - B H M Ma
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - A Tang
- College of Computing and Informatics, Sungkyunkwan University, Seoul, Republic of Korea
| | - E K Yeoh
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - S Y S Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - M Ip
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - K O Kwok
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Shenzhen Research Institute of the Chinese University of Hong Kong, Shenzhen, China; Hong Kong Institute of Asia-Pacific Studies, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
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Larsen L, Wensaas KA, Emberland KE, Rortveit G. Respiratory tract infections in Norwegian primary care 2006-2015: a registry-based study. Scand J Prim Health Care 2022; 40:173-180. [PMID: 35485789 PMCID: PMC9397465 DOI: 10.1080/02813432.2022.2069711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 02/22/2022] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Examine characteristics and time trends of respiratory tract infection (RTI) consultations in Norwegian primary care and compare consultations in daytime general practice and out-of-hours (OOH) services. DESIGN Registry-based study using reimbursement claims data. SETTING All in-person primary care consultations during 2006-2015. PATIENTS All patients visiting primary care during the study period. MAIN OUTCOME MEASURES The main outcome variable was RTI consultations. Differences regarding service type (general practice or OOH services) and changes over time were investigated. We report associations with patient age and sex, season, point-of-care C-reactive protein (CRP) test use, and sickness certificate issuing. RESULTS RTI consultations (n = 16 304 777) represented 11.6% of all consultations (N = 140 199 637) in primary care over the ten-year period. The annual number of RTI consultations per 1000 inhabitants decreased from 335 to 314, while the number of consultations for any reason increased. Of RTI consultations, 83.2% occurred in general practice. OOH services had a higher proportion of RTI consultations (21.4%) compared with general practice (10.6%). Young children (0-4 years) represented 18.9% of all patients in RTI consultations. CRP testing was used in 56.2% of RTI consultations, and use increased over time. Sickness certificates were issued in 31.9% of RTI consultations with patients of working age (20-67 years). CONCLUSION Most RTI consultations occurred in general practice, although the proportion was higher in OOH services. Laboratory testing and/or issuing of sickness certificates were part of most consultations. This could be an important reason for seeking health care. Key PointsPatients with a respiratory tract infection (RTI) are mostly managed in primary care, where they represent much of the workload.Most consultations for RTIs took place in daytime general practice, but out-of-hours services had a higher proportion of RTI consultations.RTIs were the dominating reason for encounter among young children both in out-of-hours services and daytime general practice.CRP tests were used in over half of RTI consultations, and their use expanded over time.
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Affiliation(s)
- Leo Larsen
- Department of Global Public Health and Primary Care, Section for General Practice, University of Bergen, Bergen, Norway
| | - Knut-Arne Wensaas
- Department of Health, Research Unit for General Practice, NORCE Norwegian Research Centre AS, Bergen, Norway
| | - Knut Erik Emberland
- Department of Global Public Health and Primary Care, Section for General Practice, University of Bergen, Bergen, Norway
- Department of Health, Research Unit for General Practice, NORCE Norwegian Research Centre AS, Bergen, Norway
| | - Guri Rortveit
- Department of Global Public Health and Primary Care, Section for General Practice, University of Bergen, Bergen, Norway
- Department of Health, Research Unit for General Practice, NORCE Norwegian Research Centre AS, Bergen, Norway
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Huibers L, Vestergaard CH, Keizer E, Bech BH, Bro F, Christensen MB. Variation of GP antibiotic prescribing tendency for contacts with out-of-hours primary care in Denmark - a cross-sectional register-based study. Scand J Prim Health Care 2022; 40:227-236. [PMID: 35703579 PMCID: PMC9397449 DOI: 10.1080/02813432.2022.2073981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To study variation in antibiotic prescribing rates among general practitioners (GP) in out-of-hours (OOH) primary care and to explore GP characteristics associated with these rates. DESIGN Population-based observational registry study using routine data from the OOH primary care registration system on patient contacts and antibiotic prescriptions combined with national register data. SETTING OOH primary care of the Central Denmark Region. SUBJECTS All patient contacts in 2014-2017. MAIN OUTCOME MEASURES GPs' tendency to prescribe antibiotics. Excess variation (not attributable to chance). RESULTS We included 794,220 clinic consultations (16.1% with antibiotics prescription), 281,141 home visits (11.6% antibiotics), and 1,583,919 telephone consultations (5.8% antibiotics). The excess variation in the tendency to prescribe antibiotics was 1.56 for clinic consultations, 1.64 for telephone consultations, and 1.58 for home visits. Some GP characteristics were significantly correlated with a higher tendency to prescribe antibiotics, including 'activity level' (i.e. number of patients seen in the past hour) for clinic and telephone consultations, 'familiarity with OOH care' (i.e. number of OOH shifts in the past 180 days), male sex, and younger age for home visits. Overall, GP characteristics explained little of the antibiotic prescribing variation seen among GPs (Pseudo r2: 0.008-0.025). CONCLUSION Some variation in the GPs' tendency to prescribe antibiotics was found for OOH primary care contacts. Available GP characteristics, such as GPs' activity level and familiarity with OOH care, explained only small parts of this variation. Future research should focus on identifying factors that can explain this variation, as this knowledge could be used for designing interventions.KEY POINTSCurrent awareness:Antibiotic prescribing rates seem to be higher in out-of-hours than in daytime primary care.Most important results:Antibiotic prescribing rates varied significantly among general practitioners after adjustment for contact- and patient-characteristics.This variation remained even after accounting for variation attributable to chance.General practitioners' activity level and familiarity with out-of-hours care were positively associated with their tendency to prescribe antibiotics.
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Affiliation(s)
- Linda Huibers
- Research Unit for General Practice, Aarhus, Denmark
- CONTACT Linda Huibers Research Unit for General Practice, Bartholins Alle 2, Aarhus8000, Denmark
| | | | - Ellen Keizer
- Research Unit for General Practice, Aarhus, Denmark
| | - Bodil Hammer Bech
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Flemming Bro
- Research Unit for General Practice, Aarhus, Denmark
- Department of General Practice, Institute for Public Health, Aarhus University, Aarhus, Denmark
| | - Morten Bondo Christensen
- Research Unit for General Practice, Aarhus, Denmark
- Department of General Practice, Institute for Public Health, Aarhus University, Aarhus, Denmark
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Faiela C, Sevene E. Antibiotic prescription for HIV-positive patients in primary health care in Mozambique: A cross-sectional study. S Afr J Infect Dis 2022; 37:340. [PMID: 35284563 PMCID: PMC8905412 DOI: 10.4102/sajid.v37i1.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/24/2021] [Indexed: 11/25/2022] Open
Abstract
Background Antibiotic overuse is a major public health challenge worldwide and it can result in the emergence and spread of drug resistance. In Mozambique, there are limited data related to primary care physicians' antibiotic prescription patterns. The aim of this study was to assess the antibiotic prescription patterns for HIV- positive patients in primary health care. Methods A prospective cross-sectional quantitative study was conducted in eight primary health care units in Southern Mozambique. The study was based on recording outpatient prescriptions using a structured questionnaire. Three hundred and sixty-nine prescriptions and clinical records of HIV-positive patients from 31 prescribers were assessed. A total of eight general practitioners, 13 medical technicians and 10 nurses participated. Results Antibiotics were used in 65.9% of prescriptions, with an average of 0.9 antibiotics per prescription. Of a total of 334 prescribed antibiotics, 69.8% were for the treatment of infections and 30.2% for prophylaxis. Penicillin (29.2%), sulphonamides (19.7%), and quinolones (16.3%) were the most prescribed classes of antibiotics for treatment. For prophylaxis, only sulphonamides (93.1%) and macrolides (6.9%) were prescribed. The diagnosis was the only variable that had a significant association with antibiotic prescription (p < 0.001). Most of penicillins (68.0%) and sulphonamides (21.4%) were prescribed to treat infections related to the respiratory tract. Conclusion The prescription of antibiotics was high and influenced by patient clinical conditions. Antibiotics were prescribed either for treatment or prophylaxis of infections, mostly to treat respiratory tract infections. Prescribers should be encouraged to adopt a rational use of antibiotics to reduce unnecessary prescriptions.
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Affiliation(s)
- Candido Faiela
- Department of Biological Science, Faculty of Science, Eduardo Mondlane University, Maputo, Mozambique
- Department of Physiological Science, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Esperanca Sevene
- Department of Physiological Science, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
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Gunnlaugsdottir MR, Linnet K, Jonsson JS, Blondal AB. Encouraging rational antibiotic prescribing behaviour in primary care - prescribing practice among children aged 0-4 years 2016-2018: an observational study. Scand J Prim Health Care 2021; 39:373-381. [PMID: 34348560 PMCID: PMC8475099 DOI: 10.1080/02813432.2021.1958506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To study antibiotic prescriptions among 0- to 4-year-old children before and after implementing a quality project on prudent prescribing of antibiotics in primary healthcare in the capital region of Iceland. DESIGN An observational, descriptive, retrospective study using quantitative methodology. SETTING Primary healthcare in the Reykjavik area with a total population of approximately 220,000. SUBJECTS A total of 6420 children 0-4 years of age presenting at the primary healthcare centres in the metropolitan area over three years from 2016 to 2018. MAIN OUTCOME MEASURES Reduction of antibiotic prescriptions and change in antibiotic profile. Data on antibiotic prescriptions for children 0-4 years of age was obtained from the medical records. Out-of-hours prescriptions were not included in the database. RESULTS The number of prescriptions during the study period ranged from 263.6 to 289.6 prescriptions/1000 inhabitants/year. A reduction of 9% in the total number of prescriptions between 2017-2018 was observed. More than half of all prescriptions were for otitis media, followed by pneumonia and skin infections. Amoxicillin accounted for over half of all prescriptions, increasing between 2016 and 2018 by 51.3%. During this period, the prescribing of co-amoxiclav and macrolides decreased by 52.3% and 40.7%, respectively. These changes were significant in all cases, p < 0.0001. CONCLUSION The results show an overall decrease in antibiotic prescribing concurrent with a change in the choice of antibiotics prescribed and in line with the recommendations presented in the prescribing guidelines implemented by the Primary Healthcare of the Capital Area, and consistent with the project's goals.Key pointsA substantial proportion of antibiotic prescribing can be considered inappropriate and the antibiotic prescription rate is highest in Iceland of the Nordic countries.After implementing guidance on the treatment of common infections together with feedback on antibiotic prescribing, a decrease in the total number of prescriptions accompanied by a shift in the antibiotic profile was observed.
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Affiliation(s)
| | | | - Jon Steinar Jonsson
- Development Centre for Primary Healthcare, Iceland
- Department of Family Medicine, University of Iceland, Reykjavík, Iceland
| | - Anna Bryndis Blondal
- Faculty of Pharmaceutical Sciences, University of Iceland, Reykjavík, Iceland
- Development Centre for Primary Healthcare, Iceland
- CONTACT Anna Bryndis Blondal , Faculty of Pharmaceutical Sciences, University of Iceland, Reykjavík, Iceland
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Bergene EH, Nordeng H, Rø TB, Steinsbekk A. Requests for new oral antibiotic prescriptions in children within 2 days: a Norwegian population-based study. Fam Pract 2018; 35:690-697. [PMID: 29746693 PMCID: PMC6290779 DOI: 10.1093/fampra/cmy033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Children commonly refuse to take antibiotics, which may induce parents to request new antibiotic prescriptions with different pharmaceutical characteristics. OBJECTIVES To investigate prescription changes for children 0-12 years receiving oral liquid or solid antibiotic formulations and to explore the relationships between prescription changes and characteristics related to the child, prescriber and antibiotic. METHODS A population-based registry study based on data from the Norwegian Prescription Database (NorPD) from 2004 to 2016. Antibiotic prescription changes were defined as the dispensing of subsequent antibiotics with different pharmaceutical characteristics to the same child within 2 days after initial prescriptions. Data were analysed using multivariable logistic regression and generalized estimating equations. RESULTS Requests for new prescriptions followed 3.0% of 2 691 483 initial antibiotic prescriptions for children. Young children who received solid formulations (10.9%) and certain poor-tasting antibiotics (8.6%) had the highest proportions of new prescriptions. Penicillin V was most commonly changed, while macrolides/lincosamides dominated subsequent prescriptions. In order of magnitude, the characteristics associated with requests for new prescriptions were the children's ages, poor taste and concentration of liquids, size and shape of solids, prescribers born in recent decades, and girl patients. Reimbursed prescriptions and scored solids were associated with fewer requests. CONCLUSIONS While only 3% of the antibiotic prescriptions were changed, the preference of broad-spectrum over narrow-spectrum antibiotics for young children in this study mirrors international prescription patterns. Avoiding the costs of children's refusal and consequent changes may thus be a motivation for choosing more preferred antibiotics.
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Affiliation(s)
- E H Bergene
- Department of Public Health and Nursing, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Central Norway Hospital Pharmacy Trust, Trondheim, Norway
| | - H Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy, University of Oslo, Oslo, Norway.,Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - T B Rø
- Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Department of Pediatrics, St Olav's Hospital, Trondheim, Norway
| | - A Steinsbekk
- Department of Public Health and Nursing, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
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11
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Prescribing antibiotics when the stakes are higher — do GPs prescribe less when patients are pregnant? A retrospective observational study. BJGP Open 2018; 2:bjgpopen18X101505. [PMID: 30564716 PMCID: PMC6184091 DOI: 10.3399/bjgpopen18x101505] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 11/09/2017] [Indexed: 11/15/2022] Open
Abstract
Background Most oral antibiotics are prescribed by GPs, and they are therefore the most important influencers with regard to improving antibiotic prescription patterns. Although GPs’ prescription patterns in general are well-studied, little is known about antibiotic prescription patterns in pregnancy. Aim To study GPs’ antibiotic prescriptions in respiratory tract infections (RTIs) during pregnancy, and assess differences, if any, between pregnant and non-pregnant patients. Design & setting Retrospective observational study combining prescription data from the Norwegian Peer Academic Detailing (Rx-PAD) study database, pregnancy data from the Norwegian birth registry, and pharmacy dispension data from the Norwegian Prescription Database (NorPD). Method Records of patient contacts with 458 GPs, between December 2004 and February 2007, were screened for RTI episodes. Similar diagnoses were grouped together, as were similar antibiotics. Episodes were categorised according to whether the patient was pregnant or not, and included women aged 16–46 years. Logistic regression models were used to assess odds ratios (ORs), and calculated relative risks (cRRs) were produced. The authors also adjusted for clustering at various levels. Results Overall prescription rate for RTI episodes was 30.8% (n = 96 830). The cohort was reduced to include only episodes with women pregnant in the study period (n = 18 890). The antibiotic prescription rate in pregnancy was 25.9% versus 34.2% in the time before and after pregnancy (cRR = 0.66 [95% confidence intervals {CI} = 0.68 to 0.81]). During pregnancy, 83.0% of the antibiotic prescriptions were picked up at a pharmacy, compared to an 86.6% filling rate in non-pregnant patients. The difference was not significant when adjusting for clustering at the patient level. Conclusion Norwegian GPs prescribe fewer antibiotics overall when patients are pregnant and, when they do prescribe, choose more narrow spectrum antibiotics for RTIs. This indicates a possible lower target rate for GP prescriptions to females. A low antibiotic dispension rate during pregnancy may represent a discussion topic in the consultation setting, to address possible reasons and avoid under-treatment.
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Walle-Hansen MM, Høye S. Geographic Variation in Antibiotic Consumption-Is It Due to Doctors' Prescribing or Patients' Consulting? Antibiotics (Basel) 2018; 7:antibiotics7010026. [PMID: 29558417 PMCID: PMC5872137 DOI: 10.3390/antibiotics7010026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/11/2018] [Accepted: 03/19/2018] [Indexed: 11/16/2022] Open
Abstract
Antibiotic consumption varies greatly between Norwegian municipalities. We examine whether this variation is associated with inhabitants' consultation rates or general practitioners' (GP) prescription rates. Our study comprises consultations and antibiotic prescriptions for respiratory tract infections (RTIs) in general practice in all Norwegian municipalities with over 5000 inhabitants in 2014. Data was collected from The Norwegian Prescription Database, The Directorate of Health's system for control and payment of health reimbursements registry and Norway Statistics. Consultation rates and prescription rates were categorised in age- and gender specific quintiles and the effect on antibiotic consumption was analysed using a Poisson regression model. We found that inhabitants with RTIs received 42% more prescriptions if they belonged to a municipality with high consultation rates compared to low consultation rates [incidence rate ratio (IRR) 1.42 (95% CI 1.41-1.44)] and 48% more prescriptions if they belonged to a municipality with high prescription rates versus low prescription rates [IRR 1.48 (95% KI 1.47-1.50)]. Our results demonstrate that inhabitants' consultation rates and GPs' prescription rates have about equal impact on the number of RTI antibiotics prescribed at municipality level. These findings highlight the importance of interventions targeting patients as well as doctors in efforts to reduce unnecessary antibiotic consumption.
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Affiliation(s)
| | - Sigurd Høye
- Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, 0315 Oslo, Norway.
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Aabenhus R, Siersma V, Sandholdt H, Køster-Rasmussen R, Hansen MP, Bjerrum L. Identifying practice-related factors for high-volume prescribers of antibiotics in Danish general practice. J Antimicrob Chemother 2018; 72:2385-2391. [PMID: 28430992 DOI: 10.1093/jac/dkx115] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/17/2017] [Indexed: 11/12/2022] Open
Abstract
Objectives In Denmark, general practice is responsible for 75% of antibiotic prescribing in the primary care sector. We aimed to identify practice-related factors associated with high prescribers, including prescribers of critically important antibiotics as defined by WHO, after accounting for case mix by practice. Methods We performed a nationwide register-based survey of antibiotic prescribing in Danish general practice from 2012 to 2013. The unit of analysis was the individual practice. We used multivariable regression analyses and an assessment of relative importance to identify practice-related factors driving high antibiotic prescribing rates. Results We included 98% of general practices in Denmark ( n = 1962) and identified a 10% group of high prescribers who accounted for 15% of total antibiotic prescriptions and 18% of critically important antibiotic prescriptions. Once case mix had been accounted for, the following practice-related factors were associated with being a high prescriber: lack of access to diagnostic tests in practice (C-reactive protein and urine culture); high use of diagnostic tests (urine culture and strep A throat test); a low percentage of antibiotic prescriptions issued over the phone compared with all antibiotic prescriptions; and a high number of consultations per 1000 patients. We also found that a low number of consultations per 1000 patients was associated with a reduced likelihood of being a high prescriber of antibiotics. Conclusions An apparent underuse or overuse of diagnostic tests in general practice as well as organizational factors were associated with high-prescribing practices. Furthermore, the choice of antibiotic type seemed less rational among high prescribers.
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Affiliation(s)
- Rune Aabenhus
- Research Unit of General Practice and Section of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- Research Unit of General Practice and Section of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Håkon Sandholdt
- Research Unit of General Practice and Section of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Køster-Rasmussen
- Research Unit of General Practice and Section of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Malene Plejdrup Hansen
- Research Unit of General Practice and Section of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.,Research Unit of General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Lars Bjerrum
- Research Unit of General Practice and Section of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
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Ahmed SMAZ, Abdelrahman SS, Saad DM, Osman IS, Osman MG, Khalil EAG. Etiological Trends and Patterns of Antimicrobial Resistance in Respiratory Infections. Open Microbiol J 2018; 12:34-40. [PMID: 29785214 PMCID: PMC5897982 DOI: 10.2174/1874285801812010034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 03/16/2018] [Accepted: 03/19/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Respiratory infections are one of the commonest causes of morbidity and mortality related to infectious diseases worldwide. The emergence of antimicrobial resistance is a major global health problem which is well established in developing countries. Good clinical suspicion and correct laboratory identification of respiratory infection causing organisms followed by the appropriate management are needed to compact both community-acquired and nosocomial infection respiratory infections. OBJECTIVES A retrospective study was carried out to elucidate the etiology of respiratory infections in Sudan, as well as to guide the physician to the best antimicrobial alternatives used in the treatment of respiratory infection. METHOD Respiratory isolates that have been morphologically identified and biologically characterized were subjected to antibiotic susceptibility testing. RESULTS A total of 1481 respiratory specimens were examined, recovering 377 organisms from 350 culture positive samples [225(59.7%) sputum, 94(24.9%) broncho-alveolar lavage (BAL), 58(15.4%) Pleural fluid], the commonest organisms were Klebsiella ssp. (25.20%) and mycobacterium tuberculosis (25.20%), followed by Staphylococcus aureus(19.89%) and Pseudomonas aeruginosa(8.49%). High rate of resistance of bacterial isolates was observed to Co-trimoxazole (BA), Ampicillin sulbactam (AS), Cefotaxime (CF) and Tetracycline (TE), being 80%, 72.3%, 68.8% and 66.9% respectively; on the other hand, very low resistance rate was found to Amikacin (AK) and Levofloxacin (LE), being 4.6% and 8.5%, respectively. CONCLUSION Guided prescription of antimicrobial agents must be implemented and controlled to limit further spread of antimicrobial resistance.
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Affiliation(s)
- Salma M. Al-Zain Ahmed
- Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
- Address correspondence to this author at the Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan; Tel: +249927790916; E-mail:
| | | | - Doua M. Saad
- Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | - Isra S. Osman
- Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
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Hueber S, Kuehlein T, Gerlach R, Tauscher M, Schedlbauer A. "What they see is what you get": Prescribing antibiotics for respiratory tract infections in primary care: Do high prescribers diagnose differently? An analysis of German routine data. PLoS One 2017; 12:e0188521. [PMID: 29220399 PMCID: PMC5722345 DOI: 10.1371/journal.pone.0188521] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 11/08/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Characteristics of high and low prescribers of antibiotics in German primary care were analysed using population data. We aimed to evaluate differences in prescribing rates and factors being associated with high prescribing, and whether high prescribers made the diagnosis of perceived bacterial infections more often. METHODS Routine data were provided by the Bavarian Association of Statutory Health Insurance Physicians. Routine data are delivered by primary care practices on a quarterly basis. We analysed data from 2011 and 2012. Patients older than 15 years with respiratory tract infections consulting a primary care physician were selected (6.647 primary care practices). Patient and physician characteristics associated with high prescribing were identified using stepwise logistic regression. RESULTS Mean prescribing rate of antibiotics was 24.9%. Prescribing rate for high prescribers was 43.5% compared to 8.5% for low prescribers. High prescribers made the diagnosis of perceived bacterial infections more often (Mhigh = 64.5%, Mlow = 45.2%). In the adjusted regression model, perceived bacterial infections were strongly associated with high prescribing (OR = 13.9, 95% CI [10.2, 18.8]). Treating patients with comorbidities was associated with lower prescribing of antibiotics (OR = 0.6, 95% CI [0.4, 0.8]). High prescribers had a higher practice volume, a higher degree of prescribing dominance, and were situated more often in deprived areas and in rural settings. INTERPRETATION Compared to findings of studies in other European countries, prescribing rates were low. There was a considerable difference between prescribing rates of high and low prescribers. Diagnostic labelling was the best predictor for high prescribing. Current guidelines recommend considering antibiotic treatment for patients with co-morbidities. In our study, treating a large number of high-risk patients was not associated with high prescribing.
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Affiliation(s)
- Susann Hueber
- Universitätsklinikum Erlangen, Institute of General Practice, Erlangen, Germany
- * E-mail:
| | - Thomas Kuehlein
- Universitätsklinikum Erlangen, Institute of General Practice, Erlangen, Germany
| | - Roman Gerlach
- Kassenärztliche Vereinigung Bayern, München, Germany
| | | | - Angela Schedlbauer
- Universitätsklinikum Erlangen, Institute of General Practice, Erlangen, Germany
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Lindberg BH, Gjelstad S, Foshaug M, Høye S. Antibiotic prescribing for acute respiratory tract infections in Norwegian primary care out-of-hours service. Scand J Prim Health Care 2017; 35:178-185. [PMID: 28569649 PMCID: PMC5499318 DOI: 10.1080/02813432.2017.1333301] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To examine factors correlating with antibiotic prescribing for acute respiratory tract infections (ARTIs) in Norwegian primary care out-of-hours service. MATERIALS AND METHODS Retrospective data analysis for the year 2014 in two out-of-hours primary care units located in the towns of Hamar and Tønsberg in Norway, analysing type and frequency of different antibiotics prescribed by 117 medical doctors for ARTIs, and factors correlating with these. RESULTS The 117 doctors in two out-of-hours units diagnosed 6757 cases of ARTIs. 2310 (34.2%) of these resulted in an antibiotic prescription, where of 1615 (69.9%) were penicillin V (PcV). Tonsillitis and sinusitis were the two ARTI diagnoses with the highest antibiotic prescription rate. The antibiotic prescription rate increased successively with increasing activity level, measured as shorter median duration of consultations per session, from 28.7% (reference) in the least busy quintile of sessions to 36.6% (OR: 1.38 (95% CI =1.06-1.80)) in the busiest quintile of sessions. Prescribing of broad-spectrum antibiotics was not correlated with median duration of consultations per session. Female doctors had an OR of 0.61 (0.40-0.92) of a broad-spectrum antibiotic prescription compared to their male colleagues. CONCLUSIONS Antibiotic prescribing for ARTIs in the primary care out-of-hours services investigated is at the same level as in Norwegian general practice, but with a higher prescription rate of PcV. Antibiotic prescribing increases on busy sessions, measured as median duration of consultations per session. The work frame in primary care out-of-hours service might influence the quality of clinical decisions.
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Affiliation(s)
- Bent H. Lindberg
- Hamar Out-of-hours Primary Care Centre, Hamar, Norway
- Department of General Practice, Institute of Health and Society, University of Oslo, Hamar, Norway
- CONTACT Bent H. Lindberg Department of General Practice, Institute of Health and Society, University of Oslo, Skolegata 32, 2318 Hamar, Norway
| | - Svein Gjelstad
- Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Mats Foshaug
- Tønsberg Out-of-hours Primary Care Centre, Vestfold, Norway
| | - Sigurd Høye
- Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
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Strandberg EL, Brorsson A, André M, Gröndal H, Mölstad S, Hedin K. Interacting factors associated with Low antibiotic prescribing for respiratory tract infections in primary health care - a mixed methods study in Sweden. BMC FAMILY PRACTICE 2016; 17:78. [PMID: 27430895 PMCID: PMC4950701 DOI: 10.1186/s12875-016-0494-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 07/13/2016] [Indexed: 11/12/2022]
Abstract
Background Prescribing of antibiotics for common infections varies widely, and there is no medical explanation. Systematic reviews have highlighted factors that may influence antibiotic prescribing and that this is a complex process. It is unclear how factors interact and how the primary care organization affects diagnostic procedures and antibiotic prescribing. Therefore, we sought to explore and understand interactions between factors influencing antibiotic prescribing for respiratory tract infections in primary care. Methods Our mixed methods design was guided by the Triangulation Design Model according to Creswell. Quantitative and qualitative data were collected in parallel. Quantitative data were collected by prescription statistics, questionnaires to patients, and general practitioners’ audit registrations. Qualitative data were collected through observations and semi-structured interviews. Results From the analysis of the data from the different sources an overall theme emerged: A common practice in the primary health care centre is crucial for low antibiotic prescribing in line with guidelines. Several factors contribute to a common practice, such as promoting management and leadership, internalized guidelines including inter-professional discussions, the general practitioner’s diagnostic process, nurse triage, and patient expectation. These factors were closely related and influenced each other. The results showed that knowledge must be internalized and guidelines need to be normative for the group as well as for every individual. Conclusions Low prescribing is associated with adapted and transformed guidelines within all staff, not only general practitioners. Nurses’ triage and self-care advice played an important role. Encouragement from the management level stimulated inter-professional discussions about antibiotic prescribing. Informal opinion moulders talking about antibiotic prescribing was supported by the managers. Finally, continuous professional development activities were encouraged for up-to-date knowledge.
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Affiliation(s)
- Eva Lena Strandberg
- Department of Clinical Sciences, Malmö, Family Medicine, Lund University, Malmö, Sweden. .,Blekinge Centre of Competence, Blekinge County Council, Karlskrona, Sweden.
| | - Annika Brorsson
- Department of Clinical Sciences, Malmö, Family Medicine, Lund University, Malmö, Sweden.,Center for Primary Health Care Research, Malmö, Skåne Region, Sweden
| | - Malin André
- Department of Medicine and Health Sciences, Family Medicine, Linköping University, Linköping, Sweden.,Department of Public Health and Caring Sciences - Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Hedvig Gröndal
- Department of Sociology Uppsala, Uppsala University, Uppsala, Sweden
| | - Sigvard Mölstad
- Department of Clinical Sciences, Malmö, Family Medicine, Lund University, Malmö, Sweden
| | - Katarina Hedin
- Department of Clinical Sciences, Malmö, Family Medicine, Lund University, Malmö, Sweden.,Department of Research and Development, Region Kronoberg, Växjö, Sweden
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19
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Kim Y, Lee S, Park S, Na HO, Tchoe B. Outpatient Antibiotic Prescription Patterns for Respiratory Tract Infections of Infants. HEALTH POLICY AND MANAGEMENT 2015. [DOI: 10.4332/kjhpa.2015.25.4.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Mostafavi N, Rashidian A, Karimi-Shahanjarini A, Khosravi A, Kelishadi R. The rate of antibiotic utilization in Iranian under 5-year-old children with acute respiratory tract illness: A nationwide community-based study. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2015; 20:429-33. [PMID: 26487870 PMCID: PMC4590196 DOI: 10.4103/1735-1995.163952] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: To investigate the prevalence of antibiotic usage in children aged <5 years with acute respiratory tract illness (ARTI) in Iran. Materials and Methods: Data were collected from a national health survey conducted in 2010 (Iran's Multiple Indicator Demographic and Health Survey). Participants of this cross-sectional study were selected by multistage stratified cluster-random sampling from 31 provinces of Iran. Parents of children with <5 years of age responded to questions about the occurrence of any cough during the previous 2 weeks, referral to private/governmental/other health care systems, and utilization of any oral/injection form of antibiotics. Data were analyzed using SPSS software18. The chi-square test was used to determine antibiotic consumption in various gender and residency groups and also a place of residence with the referral health care system. Results: Of the 9345 children under 5 years who participated in the study, 1506 cases (16.2%) had ARTI during 2 weeks prior to the interview, in whom 1143 (75.9%) were referred to urban or rural health care centers (43.4 vs. 30.4%; P < 0.001). Antibiotics were utilized by 715 (62.6%) of affected children. Injection formulations were used for 150 (13.1%) patients. The frequency of receiving antibiotics was higher in urban than in rural inhabitants (66.0% vs. 57.7% P < 0.05). Conclusion: The prevalence of total and injection antibiotics usage in children <5 years with ARTI is alarmingly high in Iran. Therefore, interventions to reduce antibiotic use are urgently needed.
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Affiliation(s)
- Nasser Mostafavi
- Department of Pediatric Infectious Diseases, Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Akram Karimi-Shahanjarini
- Department of Public Health, School of Public Health, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Ardeshir Khosravi
- Department of Public Health, Technical Group for Health Information System and Secretariat for Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Roya Kelishadi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
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Tell D, Engström S, Mölstad S. Adherence to guidelines on antibiotic treatment for respiratory tract infections in various categories of physicians: a retrospective cross-sectional study of data from electronic patient records. BMJ Open 2015; 5:e008096. [PMID: 26179648 PMCID: PMC4513445 DOI: 10.1136/bmjopen-2015-008096] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To study how prescription patterns concerning respiratory tract infections differ between interns, residents, younger general practitioners (GPs), older GPs and locums. DESIGN Retrospective study of structured data from electronic patient records. SETTING Data were obtained from 53 health centres and 3 out-of-hours units in Jönköping County, Sweden, through their common electronic medical record database. PARTICIPANTS All physicians working in primary care during the 2-year study period (1 November 2010 to 31 October 2012). OUTCOME MEASURES Physicians' adherence to current guidelines for respiratory tract infections regarding the use of antibiotics. RESULTS We found considerable differences in prescribing patterns between physician categories. The recommended antibiotic, phenoxymethylpenicillin, was more often prescribed by interns, residents and younger GPs, while older GPs and locums to a higher degree prescribed broad-spectrum antibiotics. The greatest differences were seen when the recommendation in guidelines was to refrain from antibiotics, as for acute bronchitis. Interns and residents most often followed guidelines, while compliance in descending order was: young GPs, older GPs and locums. We also noticed that male doctors were somewhat overall more restrictive with antibiotics than female doctors. CONCLUSIONS In general, primary care doctors followed national guidelines on choice of antibiotics when treating respiratory tract infections in children but to a lesser degree when treating adults. Refraining from antibiotics seems harder. Adherence to national guidelines could be improved, especially for acute bronchitis and pneumonia. This was especially true for older GPs and locums whose prescription patterns were distant from the prevailing guidelines.
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Affiliation(s)
- David Tell
- Råslätt Health Care Centre, Jönköping, Sweden
| | - Sven Engström
- Primary Care Research and Development Unit, Futurum, Jönköping, Sweden
| | - Sigvard Mölstad
- Department of Clinical Sciences, General Practice, Lund University, Lund, Sweden
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22
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Truter I. Antimicrobial prescribing in South Africa using a large pharmacy database: A drug utilisation study Ilse Truter. S Afr J Infect Dis 2015. [DOI: 10.1080/23120053.2015.1054181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Gradel KO, Kaerlev L. Antibiotic use from conception to diagnosis of child leukaemia as compared to the background population: A nested case-control study. Pediatr Blood Cancer 2015; 62:1155-61. [PMID: 25790083 DOI: 10.1002/pbc.25477] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 01/16/2015] [Indexed: 11/12/2022]
Abstract
BACKGROUND The role of infection in the aetiology of childhood leukaemia is unknown. We used prescriptions of antibiotics from Danish pharmacies as a proxy measure for the occurrence of infections. PROCEDURE We investigated the association between exposure to antibiotics, from conception to leukaemia diagnosis, and the risk of leukaemia. Incident cases of leukaemia among children in Denmark, 1995-2008, with mothers having their earliest conception date in 1995, were individually matched to population controls by age, sex and municipality. Conditional logistic regression analyses assessed antibiotic redemptions in different time periods from conception up to 6 months before the diagnoses of all leukaemia types, acute lymphoblastic leukaemia [ALL] and ALL in 2- to 5-year-old children, adjusting for several potential confounders. RESULTS A total of 120/360 (33.3%) leukaemia mothers and 1,081/3,509 (30.8%) control mothers redeemed antibiotics during pregnancy (P = 0.32). For children, the equivalent numbers were 276 (76.7%) and 2,665 (75.9%) (P = 0.76). Histograms of antibiotic redemptions showed no temporal differences between leukaemia mothers/children and controls, which was confirmed in adjusted regression analyses (OR [95% CI]: 1.02 [0.75-1.38]). Only antibiotics redeemed during the first year after birth differed from this (OR [95% CI] for ALL diagnosed in 2- to 5-year-old children: 0.46 [0.31-0.66]). CONCLUSIONS In this hypothesis generating study, the similar amount and pattern of antibiotic redemptions in children with and without leukaemia indicate that infections play a minor role in the aetiology of childhood leukaemia. However, less antibiotic redemptions during the first year of life conform to Greaves' 'delayed infection hypothesis'.
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Affiliation(s)
- Kim Oren Gradel
- Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
| | - Linda Kaerlev
- Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
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Effects on antibiotic dispensing rates of interventions to promote delayed prescribing for respiratory tract infections in primary care. Br J Gen Pract 2014; 63:e777-86. [PMID: 24267861 DOI: 10.3399/bjgp13x674468] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Delayed antibiotic prescribing is an effective method of reducing the consumption of antibiotics for respiratory tract infections (RTIs). However, interventions to promote its use remain unexplored. AIM To measure the effects of a GP educational intervention and a computer delayed-prescribing pop-up reminder on antibiotic-dispensing rates. The study also aimed to identify factors influencing GPs' decisions to issue delayed prescriptions and patients' decisions to fill their prescriptions. DESIGN AND SETTING Controlled trial nested within a cluster-randomised controlled trial in urban and rural practices in 11 counties in southern Norway. METHOD Educational intervention and control groups were randomly populated from 81 continuing medical education groups. Within the intervention arm, 107 of the 156 participating GPs were assigned, based on the electronic patient-record system they used, to having a pop-up reminder installed on their computers. Data on prescribed and dispensed antibiotics from 1 year before, and 1 year during, the intervention were collected and linked. RESULTS Valid data were obtained from 328 GPs (75%). At baseline, 92.1% of prescriptions were filled at pharmacies. The effect of the educational intervention was a 1% reduction in approximated risk (risk ratio [RR] 0.99, 95% confidence interval [CI] = 0.96 to 1.01) of antibiotics being dispensed, while the combined effect of the educational and pop-up reminder intervention was a 4% reduction in approximated risk (RR 0.96, 95% CI = 0.94 to 0.98). In the pop-up intervention group, 11.0% of the prescriptions were issued as delayed prescriptions and 59.2% of these were filled. Upper RTI, sinusitis, and otitis gave highest odds for delayed prescribing and lowest odds for dispensing. CONCLUSION Promoting delayed prescribing among GPs results in a small decrease in antibiotic dispensing. The savings potential is greatest for upper RTI, sinusitis, and otitis.
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Gjelstad S, Høye S, Straand J, Brekke M, Dalen I, Lindbæk M. Improving antibiotic prescribing in acute respiratory tract infections: cluster randomised trial from Norwegian general practice (prescription peer academic detailing (Rx-PAD) study). BMJ 2013; 347:f4403. [PMID: 23894178 PMCID: PMC3724398 DOI: 10.1136/bmj.f4403] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
OBJECTIVE To assess the effects of a multifaceted educational intervention in Norwegian general practice aiming to reduce antibiotic prescription rates for acute respiratory tract infections and to reduce the use of broad spectrum antibiotics. DESIGN Cluster randomised controlled study. SETTING Existing continuing medical education groups were recruited and randomised to intervention or control. PARTICIPANTS 79 groups, comprising 382 general practitioners, completed the interventions and data extractions. INTERVENTIONS The intervention groups had two visits by peer academic detailers, the first presenting the national clinical guidelines for antibiotic use and recent research evidence on acute respiratory tract infections, the second based on feedback reports on each general practitioner's antibiotic prescribing profile from the preceding year. Regional one day seminars were arranged as a supplement. The control arm received a different intervention targeting prescribing practice for older patients. MAIN OUTCOME MEASURES Prescription rates and proportion of non-penicillin V antibiotics prescribed at the group level before and after the intervention, compared with corresponding data from the controls. RESULTS In an adjusted, multilevel model, the effect of the intervention on the 39 intervention groups (183 general practitioners) was a reduction (odds ratio 0.72, 95% confidence interval 0.61 to 0.84) in prescribing of antibiotics for acute respiratory tract infections compared with the controls (40 continuing medical education groups with 199 general practitioners). A corresponding reduction was seen in the odds (0.64, 0.49 to 0.82) for prescribing a non-penicillin V antibiotic when an antibiotic was issued. Prescriptions per 1000 listed patients increased from 80.3 to 84.6 in the intervention arm and from 80.9 to 89.0 in the control arm, but this reflects a greater incidence of infections (particularly pneumonia) that needed treating in the intervention arm. CONCLUSIONS The intervention led to improved antibiotic prescribing for respiratory tract infections in a representative sample of Norwegian general practitioners, and the courses were feasible to the general practitioners. TRIAL REGISTRATION Clinical trials NCT00272155.
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Affiliation(s)
- Svein Gjelstad
- Department of General Practice/Family Medicine, Institute of Health and Society, University of Oslo, P O Box 1130, Blindern, N-0318 Oslo, Norway.
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Björkman I, Berg J, Viberg N, Stålsby Lundborg C. Awareness of antibiotic resistance and antibiotic prescribing in UTI treatment: a qualitative study among primary care physicians in Sweden. Scand J Prim Health Care 2013; 31:50-5. [PMID: 23281925 PMCID: PMC3587295 DOI: 10.3109/02813432.2012.751695] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 09/12/2012] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To improve education and information for general practitioners in relation to rational antibiotic prescribing for urinary tract infection (UTI), it is important to be aware of GPs' views of resistance and how it influences their choice of UTI treatment. The aim of this study was to explore variations in views of resistance and UTI treatment decisions among general practitioners (GPs) in a county in Sweden. DESIGN Qualitative, semi-structured interviews were analysed with a phenomenographic approach and content analysis. SETTING Primary care in Kronoberg, a county in southern Sweden. Subjects. A purposeful sample of 20 GPs from 15 of 25 health centres in the county. MAIN OUTCOME MEASURES The variation of perceptions of antibiotic resistance in UTI treatment. How UTIs were treated according to the GPs. RESULTS Three different ways of viewing resistance in UTI treatment were identified. These were: (A) No problem, I have never seen resistance, (B) The problem is bigger somewhere else, and (C) The development of antibiotic resistance is serious and we must be careful. Moreover, GPs' perceptions of antibiotic resistance were mirrored in how they reported their treatment of UTIs in practice. CONCLUSION There was a hierarchal scale of how GPs viewed resistance as an issue in UTI treatment. Only GPs who expressed concerns about resistance followed prescribing guidelines completely. This offers valuable insights into the planning and most likely the outcome of awareness or educational activities aimed at changed antibiotic prescribing behaviour.
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Affiliation(s)
- Ingeborg Björkman
- Department of Public Health and Caring Sciences, Health Service Research, Uppsala University, Uppsala, Sweden.
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Oien RF, Akesson N. Bacterial cultures, rapid strep test, and antibiotic treatment in infected hard-to-heal ulcers in primary care. Scand J Prim Health Care 2012; 30:254-8. [PMID: 23050828 PMCID: PMC3520421 DOI: 10.3109/02813432.2012.711192] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE In-depth studies on antibiotic treatment for patients with hard-to-heal ulcers in primary care are lacking. The present study was undertaken to update the bacteriological spectrum for this patient group and to investigate antibiotic treatment. A further aim was to investigate the potential of a rapid strep test to find group A streptococci (GAS) causing ulcer infection. DESIGN A prospective study from August 2009 to August 2010. SETTING Blekinge Wound Healing Center. SUBJECTS Patients with clinical signs of infected hard-to-heal ulcers of any etiology. MAIN OUTCOME MEASURES A bacterial culture and a rapid strep test were taken from every ulcer to capture the bacteriological spectrum. Antibiotic treatment before and during the study period was measured. RESULTS Forty-one patients with 49 infected ulcers were recruited. Staphylococcus aureus, found in 68.8% of all cultures, was the most observed species. Group G streptococci (GGS) were found in 12.5%. GAS was found in one case where the rapid strep test was positive. Staphylococcus aureus was found in three patients out of four with clinical signs of erysipelas. Some 59% of the patients were treated with antibiotics before the study period compared with 44% during the study period. CONCLUSION Antibiotic treatment was largely reduced because of structured wound management. The current bacteriological spectrum showed high rates of GGS and erysipelas caused by Staphylococcus aureus. The rapid strep test was found useful in identifying GAS but we would not recommend its use in the clinical setting due to the low rate of GAS in this patient group.
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Affiliation(s)
- Rut F Oien
- Blekinge Wound Healing Center, Karlskrona, Sweden.
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Approaching the quality of antibiotic prescriptions in primary care using reimbursement data. Eur J Clin Microbiol Infect Dis 2012; 32:325-32. [PMID: 22983401 DOI: 10.1007/s10096-012-1743-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 08/30/2012] [Indexed: 10/27/2022]
Abstract
Our objectives for this investigation were: (i) to design quality measures of outpatient antibiotic use that could be calculated at the individual general practitioner (GP) level using reimbursement data only; and (ii) to analyse the variability in antibiotic prescriptions between GPs regarding these measures in south-eastern France. Based on the literature and international therapeutic guidelines, we designed a set of quality measures in an exploratory attempt to assess the quality of antibiotic prescriptions. We performed a cross-sectional study of antibiotic prescriptions in adults in south-eastern France in 2009, using data from the outpatient reimbursement database of the French National Health Insurance (NHI). We carried out a cluster analysis to group GPs according to their antibiotic prescribing behaviour. Six quality measures were calculated at the GP level, with wide variations in practice regarding all these measures. A six-cluster solution was identified, with one cluster grouping 56 % of the sample and made up of GPs having the most homogeneous pattern of prescription for all six quality measures, probably reflecting better antibiotic prescribing. Total pharmaceutical expenses (per patient), penicillin combinations use, quinolone use and seasonal variation of quinolone use were all positively associated with a more heterogeneous and possibly less appropriate use of antibiotics in a multivariate analysis. These quality measures could be useful to assess GPs' antibiotic prescribing behaviour in countries where no information system provides easy access to data linking drug use to a clinical condition.
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Fagan M, Mæhlen M, Lindbæk M, Berild D. Antibiotic prescribing in nursing homes in an area with low prevalence of antibiotic resistance: compliance with national guidelines. Scand J Prim Health Care 2012; 30:10-5. [PMID: 22188479 PMCID: PMC3337523 DOI: 10.3109/02813432.2011.629156] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 07/04/2011] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine antibiotic prescribing in nursing homes and determine to what degree the prescribing was in accordance with the national guidelines for antibiotic prescribing. DESIGN Retrospective examination of patients' records who were prescribed antibiotics in the period 1 March 2007 to 28 February 2008. SETTING AND PATIENTS Patients residing in the nursing homes of Arendal, Norway. MAIN OUTCOME MEASURES Choice of antibiotic in respect of the recommendations in the national guidelines for antibiotic prescribing. RESULTS A total of 714 antibiotic courses were prescribed to 327 patients yielding a prevalence of 6.6%. Compliant prescribing was 77% for urinary tract infections (UTI), 79% for respiratory tract infections (RTI), and 76% for skin and soft tissue infections (SSTI). Ciprofloxacin was responsible for 63% of non-compliant prescribing. On the respite wards there was a higher rate of total prescribing, non-compliant prescribing, and prescribing by physicians employed at the local hospital. CONCLUSION Guidelines for antibiotic use must be implemented actively and efforts to improve antibiotic prescribing in nursing homes must be aimed at both nursing home and hospital physicians.
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Affiliation(s)
- Mark Fagan
- Department of General Practice and Community Medicine, University of Oslo, Oslo, Norway.
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Determinants of quinolone versus trimethoprim-sulfamethoxazole use for outpatient urinary tract infection. Antimicrob Agents Chemother 2012; 56:1359-63. [PMID: 22232276 DOI: 10.1128/aac.05321-11] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Quinolones are increasingly favored over trimethoprim-sulfamethoxazole (TMP-SMX) for empirical treatment of uncomplicated urinary tract infection (UTI). This is associated with increasing resistance toward this broad-spectrum group of antibiotics. Our objective is to describe the prescribing patterns and identify determinants of the choice between TMP-SMX and quinolones for outpatient UTI treatment in Switzerland. An ongoing national Sentinel surveillance system was used to study 11,799 antibiotic prescriptions for UTI in adult outpatients and associated physician and patient factors between 2006 and 2008, to compare the prescription of quinolones versus that of TMP-SMX for treatment of UTI. Most UTI episodes were diagnosed as cystitis (90%). TMP-SMX was prescribed for one-fifth (22%) of UTIs. Independent predictors for prescribing quinolones were pyelonephritis and physicians with low thresholds for prescribing antibiotics for upper respiratory tract infections ("high prescribers"), whereas female patients were more likely to receive TMP-SMX. High-prescribing physicians also more often cared for patients who themselves favor antibiotic treatment (P < 0.001). Quinolones are commonly prescribed to outpatients with UTI. Nonclinical factors influence the choice of quinolones versus TMP-SMX, which may provide opportunities for interventions to improve prescribing patterns and control quinolone resistance.
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Thulesius H. Assessing research impact with Google Scholar: the most cited articles in the journal 2008-2010. Scand J Prim Health Care 2011; 29:193-5. [PMID: 22126216 PMCID: PMC3308462 DOI: 10.3109/02813432.2011.629160] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hans Thulesius
- Department of Clinical Sciences, Malmö, Family Medicine, Lund University, Kronoberg County Research Council, Växjö, Sweden
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Agdestein B, Lindbæk M, Gjelstad S. [Do general practitioners follow the national guidelines for treating urinary tract infections with antibiotics?]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2011; 131:1641-4. [PMID: 21901035 DOI: 10.4045/tidsskr.10.0396] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Incorrect use of antibiotics is a major public health concern both nationally and globally due to the development of antibiotic resistance. The goal of this study was to see if prescription of antibiotics for urinary tract infections in general practice was in accordance with national guidelines. MATERIAL AND METHODS We combined two sets of data from February and March 2003: prescriptions of antibiotics redeemed in pharmacies, and electronic billing cards collected from the National Insurance Agency from 145 general practitioners in Vestfold county. We analysed all consultations related to urinary tract problems, and we found which antibiotics had been prescribed and for how long. The treatment was then compared with the national guidelines. A logistic regression analysis identified factors associated with adequate treatment length. RESULTS Trimetoprime and mecillinam were most frequently prescribed to both genders. Sixty-nine (6 %) of the total 1,102 prescriptions were quinolones. A total of 271 (32 %) of 847 patients who were prescribed antibiotics for cystitis did not get treatment of sufficient length. Female and young patients were more often given the correct duration of treatment. Doctors with 1,000-1,500 patients more frequently prescribed sufficiently long treatment compared to other physicians. Six patients (0.5 %) were prescribed another antibiotic between two and 14 days after the first prescription. CONCLUSION The choice of antibiotics conformed well with national guidelines, but the duration of the treatment was often too short. In spite of this, only 0.5 % showed signs of relapse. A number of factors associated with adequate treatment length were identified. The empirical use of furadantin can be increased.
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Affiliation(s)
- Benedicte Agdestein
- Antibiotikasenteret for primærmedisin (ASP), Avdeling for allmennmedisin, HELSAM, Universitetet i Oslo, Norway.
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Regev-Yochay G, Raz M, Dagan R, Roizin H, Morag B, Hetman S, Ringel S, Ben-Israel N, Varon M, Somekh E, Rubinstein E. Reduction in antibiotic use following a cluster randomized controlled multifaceted intervention: the Israeli judicious antibiotic prescription study. Clin Infect Dis 2011; 53:33-41. [PMID: 21653300 DOI: 10.1093/cid/cir272] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Antibiotic overuse is of great public health concern. This study assessed whether intervention among physicians and their treated population could achieve a sustained reduction in antibiotic use, specifically in classes known to promote antibiotic resistance among children in a community setting. METHODS We performed a cluster randomized controlled multifaceted trial among 52 primary care pediatricians and the 88,000 children registered in their practices. The intervention was led by local leaders and engaged the participating physicians. It included physician focus group meetings, workshops, seminars, and practice campaigns. These activities focused on self-developed guidelines, improving parent and physician knowledge, diagnostic skills, and parent-physician communication skills that promoted awareness of antibiotic resistance. The main outcome measure was the change in annual antibiotic prescription rates (APRs) of children treated by the intervention group physicians as compared with rates among those treated by control group physicians. The study comprised a 2-year pre-intervention period, a 3-year intervention period, and a 1-year follow-up period. Mixed-effect models were used to assess risk ratios to account for the clustered study design. RESULTS A decrease in the total APR among children treated by the intervention physicians compared with those treated by the control physicians was observed in the first intervention year (APR decrease among control physicians, 40%; APR decrease among intervention physicians, 22%; relative risk [RR], .76; 95% confidence interval [CI], .75-.78). This reduction crossed over all antibiotic classes but was most prominent for macrolides (macrolide prescription rate among control physicians, 58%; macrolide prescription rate among intervention physicians, 27%; RR, .58; 95% CI, .55-.62). The effect was sustained during the 4 following years. CONCLUSIONS. Multifaceted intervention that engages the physicians in an educational process is effective in reducing APRs and can be sustained. CLINICAL TRIALS REGISTRATION NCT01187758.
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Zenner D, Shetty N. European Antibiotic Awareness Day 2011: antibiotics--a powerful tool and a dwindling resource. Fam Pract 2011; 28:471-3. [PMID: 21926061 DOI: 10.1093/fampra/cmr075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The increasing resistance of microorganisms to a range of antibiotics is of growing concern to healthcare professionals world wide. A correlation between antibiotic resistance and high prescribing rates has long been established. However, despite numerous awareness campaigns, antibiotic prescribing rates are still high and increasing in many countries including the UK. The European Antibiotic Awareness Day on 18 November 2011 provides a platform to remind prescribers and the general public about the dangers of antibiotic overuse. The key message is to encourage prudent antibiotic prescribing so that antibiotics remain a safe and effective resource for the future.
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Gjelstad S, Straand J, Dalen I, Fetveit A, Strøm H, Lindbæk M. Do general practitioners' consultation rates influence their prescribing patterns of antibiotics for acute respiratory tract infections? J Antimicrob Chemother 2011; 66:2425-33. [PMID: 21784782 DOI: 10.1093/jac/dkr295] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To examine general practitioners' (GPs') antibiotic prescribing patterns for acute respiratory tract infections (ARTIs) as compared with national guidelines. We also wanted to explore possible predictors of antibiotic prescription patterns. METHODS Observational study based on prescription data from 440 Norwegian GPs in December 2004 through to November 2005. Outcome measures were the type and frequency of antibiotic prescriptions for various ARTI diagnoses, with patients' and GPs' characteristics as explanatory variables. RESULTS In the study period, the 440 GPs treated a total of 142 900 ARTI episodes. In 33.5% [95% confidence interval (CI): 31.9%-35.1%] of these episodes an antibiotic was issued, of which penicillin V (pcV) accounted for 41.2% (95% CI: 37.4%-44.9%). GPs with a high number of total annual encounters had higher antibiotic prescription rates for ARTIs and used more non-pcV antibiotics compared with GPs with fewer annual patient encounters. GPs in the highest quintile with respect to the total annual encounter rate had 1.6 times the odds of prescribing antibiotics compared with GPs in the lowest quintile. Correspondingly, the odds of choosing a non-pcV antibiotic were 2.8 times higher in the top quintile of GPs compared with GPs in the bottom quintile with respect to antibiotic prescription rates. CONCLUSIONS ARTIs are frequently treated with antibiotics and often with broader spectrum agents than pcV, which is the recommended first-line antibiotic in the Norwegian guidelines. GPs with a high practice activity are, in general, more liberal with respect to the prescription of antibiotics for ARTIs, and the higher the antibiotic prescription rate, the larger the share of non-pcV agents.
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Affiliation(s)
- Svein Gjelstad
- Department of General Practice/Family Medicine, Institute of Health and Society, University of Oslo, PO Box 1130, Blindern, N-0318 Oslo, Norway.
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Høye S, Frich JC, Lindbæk M. Use and feasibility of delayed prescribing for respiratory tract infections: a questionnaire survey. BMC FAMILY PRACTICE 2011; 12:34. [PMID: 21592334 PMCID: PMC3114766 DOI: 10.1186/1471-2296-12-34] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Accepted: 05/18/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND Delayed prescribing of antibiotics for respiratory tract infections (RTIs) lowers the amount of antibiotics consumed. Several national treatment guidelines on RTIs recommend the strategy. When advocating treatment innovations, the feasibility and credibility of the innovation must be taken into account. The objective of this study was to explore GPs use and patients uptake of wait-and-see prescriptions for RTIs, and to investigate the feasibility of the strategy from GPs' and patients' perspectives. METHODS Questionnaire survey among Norwegian GPs issuing and patients receiving a wait-and-see-prescription for RTIs. Patients reported symptoms, confidence and antibiotics consumption, GPs reported diagnoses, reason for issuing a wait-and-see-prescription and their opinion about the method. RESULTS 304 response pairs from consultations with 49 GPs were received. The patient response rate was 80%. The most common diagnosis for the GPs to issue a wait-and-see prescription was sinusitis (33%) and otitis (21%). 46% of the patients reported to consume the antibiotics. When adjusted for other factors, the diagnosis did not predict antibiotic consumption, but both being 16 years or more (p = 0,006) and reporting to have a fever (p = 0,012) doubled the odds of antibiotic consumption, while feeling very ill more than quadrupled the odds (p = 0,002). In 210 cases (69%), the GP found delayed prescribing a very reasonable strategy, and 270 patients (89%) would prefer to receive a wait-and-see prescription in a similar situation in the future. The GPs found delayed prescribing very reasonable most frequently in cases of sinusitis (79%, p = 0,007) and least frequently in cases of lower RTIs (49%, p = 0,002). CONCLUSION Most patients and GPs are satisfied with the delayed prescribing strategy. The patients' age, symptoms and malaise are more important than the diagnosis in predicting antibiotic consumption. The GP's view of the method as a reasonable approach depends on the patient's diagnosis. In our setting, delayed prescribing seems to be a feasible strategy, especially in cases of sinusitis and otitis. Educational efforts to promote delayed prescribing in similar settings should focus on these diagnoses.
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Affiliation(s)
- Sigurd Høye
- Antibiotic Center for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, PO Box 1130 Blindern, N-0318 Oslo, Norway.
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Delayed prescribing for upper respiratory tract infections: a qualitative study of GPs' views and experiences. Br J Gen Pract 2011; 60:907-12. [PMID: 21144201 DOI: 10.3399/bjgp10x544087] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Delayed prescribing has been promoted as a strategy that meets patients' expectations and helps to avoid unnecessary use of antibiotics in upper respiratory tract infections. AIM To explore GPs' views on and experiences with delayed prescribing in patients with acute upper respiratory tract infections. DESIGN OF STUDY Qualitative study involving focus groups. Setting Norwegian general practice. METHOD Qualitative analysis of data collected from five focus groups comprising 33 GPs who took part in a quality-improvement programme of antibiotic prescribing. RESULTS The views of GPs differed on the usefulness of delayed prescribing. GPs who endorsed the strategy emphasised shared decision making and the creation of opportunities for educating patients, whereas GPs who were negative applied the strategy mainly when being pressed to prescribe. Mild and mainly harmless conditions of a possible bacterial origin, such as acute sinusitis and acute otitis, were considered most suitable for delayed prescribing. A key argument for issuing a wait-and-see prescription was that it helped patients avoid seeking after-hours care. For issuing a wait-and-see prescription, the GPs required that the patient was 'knowledgeable', able to understand the indications for antibiotics, and motivated for shared decision making. GPs emphasised that patients should be informed thoroughly when receiving a wait-and-see prescription. CONCLUSION Not all GPs endorse delayed prescribing; however, it appears to be a feasible approach for managing patients with early symptoms of mild upper respiratory tract infections of a possible bacterial origin. Informing the patients properly while issuing wait-and-see prescriptions is essential.
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Kontarakis N, Tsiligianni IG, Papadokostakis P, Giannopoulou E, Tsironis L, Moustakis V. Antibiotic prescriptions in primary health care in a rural population in Crete, Greece. BMC Res Notes 2011; 4:38. [PMID: 21320356 PMCID: PMC3042939 DOI: 10.1186/1756-0500-4-38] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 02/15/2011] [Indexed: 11/13/2022] Open
Abstract
Background Antibiotic over-prescribing has generally been considered to be common in Greece, however not much is known about current antibiotic use. Findings The aim of this study was to investigate antibiotic prescribing in a well-defined rural population of 159 adults and 99 children over a 12-month period in Crete, Greece. The daily-defined doses (DDD) for 1000 people/day (DID) were 22.1 and 24.2 for children and adults respectively. The overall DID was 23.4, markedly lower than that previously reported for Greece. The use of penicillins was 49.5% of DDD in children and 31.7% in adults. Quinolones represented 2.2% of the total antibiotics (0% in children). Prescriptions of antibiotics were more common during the 3-month period from January to March for both children and adults. Conclusions The findings of this study confirm the seasonal distribution of antibiotics used and the predominance of prescribing for respiratory tract infections. In the area of the study, antibiotic use seems to be lower than that previously reported for Greece, probably as a result of the recently established net of well-trained primary health physicians.
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Llor C, Hernández S, Sierra N, Moragas A, Hernández M, Bayona C. Association between use of rapid antigen detection tests and adherence to antibiotics in suspected streptococcal pharyngitis. Scand J Prim Health Care 2010; 28:12-7. [PMID: 20201628 PMCID: PMC3440608 DOI: 10.3109/02813431003669301] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Few studies have analysed adherence to antibiotic treatment in pharyngitis. The aim of this study was to evaluate the association of rapid antigen detection tests (RADT) and treatment adherence among patients 18 years of age or over with pharyngitis treated with different antibiotic regimens. DESIGN Prospective study from 2003 to 2008. SETTING Office-based physician practices. Intervention. The adherence of patients prior to the use of RADTs - no test was available until mid-2006 - was compared with the adherence associated with the use of RADTs. SUBJECTS Patients with suspected streptococcal pharyngitis. MAIN OUTCOME MEASURES Patient adherence was assessed by electronic monitoring. The adherence outcomes considered were antibiotic-taking adherence, correct dosing, and good timing adherence during at least 80% of the antibiotic course. RESULTS A total of 196 patients were recruited. The percentage of container openings was 77.9%+/-17.7%, being significantly higher for patients in whom the RADTs were performed compared with those in whom this test was not undertaken (80.1% vs. 70.8% for thrice-daily antibiotic regimens and 88.1% vs. 76.5% for twice-daily regimens; p < 0.01). The other variables of adherence were also better among patients undergoing RADT in both those who took at least 80% of the pills (71.3% vs. 42.2%; p < 0.001) as well as those with good timing adherence (52.5% vs. 32.8%; p < 0.01). Furthermore, correct dosing was always greater when the patient had undergone an RADT. CONCLUSION Adherence to antibiotic treatment is higher when an RADT is carried out at the consultation prior to administration of antibiotic treatment.
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Affiliation(s)
- Carl Llor
- Primary Care Centre Jaume I, Tarragona, University Rovira i Virgili, Spain.
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Berild D, Lindbæk M. Antibiotikabruk til bekymring. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2010; 130:2010. [DOI: 10.4045/tidsskr.10.0981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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