Health Alliance for prudent antibiotic prescribing in patients with respiratory tract infections (HAPPY AUDIT) -impact of a non-randomised multifaceted intervention programme

Lars Bjerrum, Anders Munck, Bente Gahrn-Hansen, Malene Plejdrup Hansen, Dorte Ejg Jarbol, Gloria Cordoba, Carl Llor, Josep Maria Cots, Silvia Hernández, Beatriz González López-Valcárcel, Antonia Pérez, Lidia Caballero, Walter von der Heyde, Ruta Radzeviciene, Arnoldas Jurgutis, Anatoliy Reutskiy, Elena Egorova, Eva Lena Strandberg, Ingvar Ovhed, Sigvard Mölstad & 5 others Robert Vander Stichele, Ria Benko, Vera Vlahovic-Palcevski, Christos Lionis, Marit Rønning

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Abstract

BACKGROUND: Excessive use of antibiotics is worldwide the most important reason for development of antimicrobial resistance. As antibiotic resistance may spread across borders, high prevalence countries may serve as a source of bacterial resistance for countries with a low prevalence. Therefore, bacterial resistance is an important issue with a potential serious impact on all countries. Initiatives have been taken to improve the quality of antibiotic prescribing in primary care, but only few studies have been designed to determine the effectiveness of multifaceted strategies across countries with different practice setting. The aim of this study was to evaluate the impact of a multifaceted intervention targeting general practitioners (GPs) and patients in six countries with different health organization and different prevalence of antibiotic resistance.

METHODS: GPs from two Nordic countries, two Baltic Countries and two Hispano-American countries registered patients with respiratory tract infections (RTIs) in 2008 and 2009. After first registration they received individual prescriber feedback and they were offered an intervention programme that included training courses, clinical guidelines, posters for waiting rooms, patient brochures and access to point of care tests (Strep A and C-Reactive Protein). Antibiotic prescribing rates were compared before and after the intervention.

RESULTS: A total of 440 GPs registered 47011 consultations; 24436 before the intervention (2008) and 22575 after the intervention (2009). After the intervention, the GPs significantly reduced the percentage of consultations resulting in an antibiotic prescription. In patients with lower RTI the GPs in Lithuania reduced the prescribing rate by 42%, in Russia by 25%, in Spain by 25%, and in Argentina by 9%. In patients with upper RTIs, the corresponding reductions in the antibiotic prescribing rates were in Lithania 20%, in Russia 15%, in Spain 9%, and in Argentina 5%.

CONCLUSION: A multifaceted intervention programme targeting GPs and patients and focusing on improving diagnostic procedures in patients with RTIs may lead to a marked reduction in antibiotic prescribing. The pragmatic before-after design used may suffer from some limitations and the reduction in antibiotic prescribing could be influenced by factors not related to the intervention.

Original languageEnglish
Pages (from-to)52
JournalBMC Family Practice
Volume12
DOIs
Publication statusPublished - 20 Jun 2011
Externally publishedYes

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Insurance Pools
Respiratory Tract Infections
General Practitioners
Anti-Bacterial Agents
Russia
Argentina
Microbial Drug Resistance
Spain
Referral and Consultation
Point-of-Care Systems
Lithuania
Scandinavian and Nordic Countries
Posters
Patients' Rooms
Pamphlets
C-Reactive Protein
Prescriptions
Primary Health Care
Organizations
Guidelines

Cite this

Bjerrum, Lars ; Munck, Anders ; Gahrn-Hansen, Bente ; Hansen, Malene Plejdrup ; Jarbol, Dorte Ejg ; Cordoba, Gloria ; Llor, Carl ; Cots, Josep Maria ; Hernández, Silvia ; López-Valcárcel, Beatriz González ; Pérez, Antonia ; Caballero, Lidia ; von der Heyde, Walter ; Radzeviciene, Ruta ; Jurgutis, Arnoldas ; Reutskiy, Anatoliy ; Egorova, Elena ; Strandberg, Eva Lena ; Ovhed, Ingvar ; Mölstad, Sigvard ; Stichele, Robert Vander ; Benko, Ria ; Vlahovic-Palcevski, Vera ; Lionis, Christos ; Rønning, Marit. / Health Alliance for prudent antibiotic prescribing in patients with respiratory tract infections (HAPPY AUDIT) -impact of a non-randomised multifaceted intervention programme. In: BMC Family Practice. 2011 ; Vol. 12. pp. 52.
@article{8a4e1fac5d22480582a16c984d9a9dd0,
title = "Health Alliance for prudent antibiotic prescribing in patients with respiratory tract infections (HAPPY AUDIT) -impact of a non-randomised multifaceted intervention programme",
abstract = "BACKGROUND: Excessive use of antibiotics is worldwide the most important reason for development of antimicrobial resistance. As antibiotic resistance may spread across borders, high prevalence countries may serve as a source of bacterial resistance for countries with a low prevalence. Therefore, bacterial resistance is an important issue with a potential serious impact on all countries. Initiatives have been taken to improve the quality of antibiotic prescribing in primary care, but only few studies have been designed to determine the effectiveness of multifaceted strategies across countries with different practice setting. The aim of this study was to evaluate the impact of a multifaceted intervention targeting general practitioners (GPs) and patients in six countries with different health organization and different prevalence of antibiotic resistance.METHODS: GPs from two Nordic countries, two Baltic Countries and two Hispano-American countries registered patients with respiratory tract infections (RTIs) in 2008 and 2009. After first registration they received individual prescriber feedback and they were offered an intervention programme that included training courses, clinical guidelines, posters for waiting rooms, patient brochures and access to point of care tests (Strep A and C-Reactive Protein). Antibiotic prescribing rates were compared before and after the intervention.RESULTS: A total of 440 GPs registered 47011 consultations; 24436 before the intervention (2008) and 22575 after the intervention (2009). After the intervention, the GPs significantly reduced the percentage of consultations resulting in an antibiotic prescription. In patients with lower RTI the GPs in Lithuania reduced the prescribing rate by 42{\%}, in Russia by 25{\%}, in Spain by 25{\%}, and in Argentina by 9{\%}. In patients with upper RTIs, the corresponding reductions in the antibiotic prescribing rates were in Lithania 20{\%}, in Russia 15{\%}, in Spain 9{\%}, and in Argentina 5{\%}.CONCLUSION: A multifaceted intervention programme targeting GPs and patients and focusing on improving diagnostic procedures in patients with RTIs may lead to a marked reduction in antibiotic prescribing. The pragmatic before-after design used may suffer from some limitations and the reduction in antibiotic prescribing could be influenced by factors not related to the intervention.",
author = "Lars Bjerrum and Anders Munck and Bente Gahrn-Hansen and Hansen, {Malene Plejdrup} and Jarbol, {Dorte Ejg} and Gloria Cordoba and Carl Llor and Cots, {Josep Maria} and Silvia Hern{\'a}ndez and L{\'o}pez-Valc{\'a}rcel, {Beatriz Gonz{\'a}lez} and Antonia P{\'e}rez and Lidia Caballero and {von der Heyde}, Walter and Ruta Radzeviciene and Arnoldas Jurgutis and Anatoliy Reutskiy and Elena Egorova and Strandberg, {Eva Lena} and Ingvar Ovhed and Sigvard M{\"o}lstad and Stichele, {Robert Vander} and Ria Benko and Vera Vlahovic-Palcevski and Christos Lionis and Marit R{\o}nning",
year = "2011",
month = "6",
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doi = "10.1186/1471-2296-12-52",
language = "English",
volume = "12",
pages = "52",
journal = "BMC Family Practice",
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Bjerrum, L, Munck, A, Gahrn-Hansen, B, Hansen, MP, Jarbol, DE, Cordoba, G, Llor, C, Cots, JM, Hernández, S, López-Valcárcel, BG, Pérez, A, Caballero, L, von der Heyde, W, Radzeviciene, R, Jurgutis, A, Reutskiy, A, Egorova, E, Strandberg, EL, Ovhed, I, Mölstad, S, Stichele, RV, Benko, R, Vlahovic-Palcevski, V, Lionis, C & Rønning, M 2011, 'Health Alliance for prudent antibiotic prescribing in patients with respiratory tract infections (HAPPY AUDIT) -impact of a non-randomised multifaceted intervention programme' BMC Family Practice, vol. 12, pp. 52. https://doi.org/10.1186/1471-2296-12-52

Health Alliance for prudent antibiotic prescribing in patients with respiratory tract infections (HAPPY AUDIT) -impact of a non-randomised multifaceted intervention programme. / Bjerrum, Lars; Munck, Anders; Gahrn-Hansen, Bente; Hansen, Malene Plejdrup; Jarbol, Dorte Ejg; Cordoba, Gloria; Llor, Carl; Cots, Josep Maria; Hernández, Silvia; López-Valcárcel, Beatriz González; Pérez, Antonia; Caballero, Lidia; von der Heyde, Walter; Radzeviciene, Ruta; Jurgutis, Arnoldas; Reutskiy, Anatoliy; Egorova, Elena; Strandberg, Eva Lena; Ovhed, Ingvar; Mölstad, Sigvard; Stichele, Robert Vander; Benko, Ria; Vlahovic-Palcevski, Vera; Lionis, Christos; Rønning, Marit.

In: BMC Family Practice, Vol. 12, 20.06.2011, p. 52.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Health Alliance for prudent antibiotic prescribing in patients with respiratory tract infections (HAPPY AUDIT) -impact of a non-randomised multifaceted intervention programme

AU - Bjerrum, Lars

AU - Munck, Anders

AU - Gahrn-Hansen, Bente

AU - Hansen, Malene Plejdrup

AU - Jarbol, Dorte Ejg

AU - Cordoba, Gloria

AU - Llor, Carl

AU - Cots, Josep Maria

AU - Hernández, Silvia

AU - López-Valcárcel, Beatriz González

AU - Pérez, Antonia

AU - Caballero, Lidia

AU - von der Heyde, Walter

AU - Radzeviciene, Ruta

AU - Jurgutis, Arnoldas

AU - Reutskiy, Anatoliy

AU - Egorova, Elena

AU - Strandberg, Eva Lena

AU - Ovhed, Ingvar

AU - Mölstad, Sigvard

AU - Stichele, Robert Vander

AU - Benko, Ria

AU - Vlahovic-Palcevski, Vera

AU - Lionis, Christos

AU - Rønning, Marit

PY - 2011/6/20

Y1 - 2011/6/20

N2 - BACKGROUND: Excessive use of antibiotics is worldwide the most important reason for development of antimicrobial resistance. As antibiotic resistance may spread across borders, high prevalence countries may serve as a source of bacterial resistance for countries with a low prevalence. Therefore, bacterial resistance is an important issue with a potential serious impact on all countries. Initiatives have been taken to improve the quality of antibiotic prescribing in primary care, but only few studies have been designed to determine the effectiveness of multifaceted strategies across countries with different practice setting. The aim of this study was to evaluate the impact of a multifaceted intervention targeting general practitioners (GPs) and patients in six countries with different health organization and different prevalence of antibiotic resistance.METHODS: GPs from two Nordic countries, two Baltic Countries and two Hispano-American countries registered patients with respiratory tract infections (RTIs) in 2008 and 2009. After first registration they received individual prescriber feedback and they were offered an intervention programme that included training courses, clinical guidelines, posters for waiting rooms, patient brochures and access to point of care tests (Strep A and C-Reactive Protein). Antibiotic prescribing rates were compared before and after the intervention.RESULTS: A total of 440 GPs registered 47011 consultations; 24436 before the intervention (2008) and 22575 after the intervention (2009). After the intervention, the GPs significantly reduced the percentage of consultations resulting in an antibiotic prescription. In patients with lower RTI the GPs in Lithuania reduced the prescribing rate by 42%, in Russia by 25%, in Spain by 25%, and in Argentina by 9%. In patients with upper RTIs, the corresponding reductions in the antibiotic prescribing rates were in Lithania 20%, in Russia 15%, in Spain 9%, and in Argentina 5%.CONCLUSION: A multifaceted intervention programme targeting GPs and patients and focusing on improving diagnostic procedures in patients with RTIs may lead to a marked reduction in antibiotic prescribing. The pragmatic before-after design used may suffer from some limitations and the reduction in antibiotic prescribing could be influenced by factors not related to the intervention.

AB - BACKGROUND: Excessive use of antibiotics is worldwide the most important reason for development of antimicrobial resistance. As antibiotic resistance may spread across borders, high prevalence countries may serve as a source of bacterial resistance for countries with a low prevalence. Therefore, bacterial resistance is an important issue with a potential serious impact on all countries. Initiatives have been taken to improve the quality of antibiotic prescribing in primary care, but only few studies have been designed to determine the effectiveness of multifaceted strategies across countries with different practice setting. The aim of this study was to evaluate the impact of a multifaceted intervention targeting general practitioners (GPs) and patients in six countries with different health organization and different prevalence of antibiotic resistance.METHODS: GPs from two Nordic countries, two Baltic Countries and two Hispano-American countries registered patients with respiratory tract infections (RTIs) in 2008 and 2009. After first registration they received individual prescriber feedback and they were offered an intervention programme that included training courses, clinical guidelines, posters for waiting rooms, patient brochures and access to point of care tests (Strep A and C-Reactive Protein). Antibiotic prescribing rates were compared before and after the intervention.RESULTS: A total of 440 GPs registered 47011 consultations; 24436 before the intervention (2008) and 22575 after the intervention (2009). After the intervention, the GPs significantly reduced the percentage of consultations resulting in an antibiotic prescription. In patients with lower RTI the GPs in Lithuania reduced the prescribing rate by 42%, in Russia by 25%, in Spain by 25%, and in Argentina by 9%. In patients with upper RTIs, the corresponding reductions in the antibiotic prescribing rates were in Lithania 20%, in Russia 15%, in Spain 9%, and in Argentina 5%.CONCLUSION: A multifaceted intervention programme targeting GPs and patients and focusing on improving diagnostic procedures in patients with RTIs may lead to a marked reduction in antibiotic prescribing. The pragmatic before-after design used may suffer from some limitations and the reduction in antibiotic prescribing could be influenced by factors not related to the intervention.

U2 - 10.1186/1471-2296-12-52

DO - 10.1186/1471-2296-12-52

M3 - Article

VL - 12

SP - 52

JO - BMC Family Practice

JF - BMC Family Practice

SN - 1471-2296

ER -