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Approaching the quality of antibiotic prescriptions in primary care using reimbursement data

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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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References

  1. Adriaenssens N, Coenen S, Versporten A, Muller A, Minalu G, Faes C, Vankerckhoven V, Aerts M, Hens N, Molenberghs G, Goossens H; ESAC Project Group (2011) European Surveillance of Antimicrobial Consumption (ESAC): outpatient antibiotic use in Europe (1997–2009). J Antimicrob Chemother 66(Suppl 6):vi3–vi12. doi:10.1093/jac/dkr453

    Article  PubMed  CAS  Google Scholar 

  2. Sabuncu E, David J, Bernède-Bauduin C, Pépin S, Leroy M, Boëlle PY, Watier L, Guillemot D (2009) Significant reduction of antibiotic use in the community after a nationwide campaign in France, 2002–2007. PLoS Med 6(6):e1000084. doi:10.1371/journal.pmed.1000084

    Article  PubMed  Google Scholar 

  3. Chahwakilian P, Huttner B, Schlemmer B, Harbarth S (2011) Impact of the French campaign to reduce inappropriate ambulatory antibiotic use on the prescription and consultation rates for respiratory tract infections. J Antimicrob Chemother 66(12):2872–2879. doi:10.1093/jac/dkr387

    Article  PubMed  CAS  Google Scholar 

  4. Steinke DT, Bain DJ, MacDonald TM, Davey PG (2000) Practice factors that influence antibiotic prescribing in general practice in Tayside. J Antimicrob Chemother 46(3):509–512

    Article  PubMed  CAS  Google Scholar 

  5. De Sutter AI, De Meyere MJ, De Maeseneer JM, Peersman WP (2001) Antibiotic prescribing in acute infections of the nose or sinuses: a matter of personal habit? Fam Pract 18(2):209–213

    Article  PubMed  Google Scholar 

  6. Johnson Z, Hayes C, Dack P (1997) The standardized prescribing ratio—a new method for comparing prescribing between GPs, controlling for patient age and sex. Pharmacoepidemiol Drug Saf 6(5):337–345. doi:10.1002/(SICI)1099-1557(199709/10)6:5<337::AID-PDS298>3.0.CO;2-P

    Article  PubMed  CAS  Google Scholar 

  7. Cadieux G, Abrahamowicz M, Dauphinee D, Tamblyn R (2011) Are physicians with better clinical skills on licensing examinations less likely to prescribe antibiotics for viral respiratory infections in ambulatory care settings? Med Care 49(2):156–165. doi:10.1097/MLR.0b013e3182028c1a

    Article  PubMed  Google Scholar 

  8. Wang KY, Seed P, Schofield P, Ibrahim S, Ashworth M (2009) Which practices are high antibiotic prescribers? A cross-sectional analysis. Br J Gen Pract 59(567):e315–e320. doi:10.3399/bjgp09X472593

    Article  PubMed  Google Scholar 

  9. Gjelstad S, Dalen I, Lindbaek M (2009) GPs’ antibiotic prescription patterns for respiratory tract infections—still room for improvement. Scand J Prim Health Care 27(4):208–215. doi:10.3109/02813430903438718

    Article  PubMed  Google Scholar 

  10. Adriaenssens N, Coenen S, Tonkin-Crine S, Verheij TJ, Little P, Goossens H; on behalf of the ESAC Project Group (2011) European Surveillance of Antimicrobial Consumption (ESAC): disease-specific quality indicators for outpatient antibiotic prescribing. BMJ Qual Saf. doi:10.1136/bmjqs.2010.049049

  11. Coenen S, Ferech M, Haaijer-Ruskamp FM, Butler CC, Vander Stichele RH, Verheij TJ, Monnet DL, Little P, Goossens H; ESAC Project Group (2007) European Surveillance of Antimicrobial Consumption (ESAC): quality indicators for outpatient antibiotic use in Europe. Qual Saf Health Care 16(6):440–445. doi:10.1136/qshc.2006.021121

    Article  PubMed  Google Scholar 

  12. Pulcini C, Lions C, Ventelou B, Verger P (2012) Drug-specific quality indicators assessing outpatient antibiotic use among French general practitioners. Eur J Public Health. doi:10.1093/eurpub/cks100

  13. Adriaenssens N, Coenen S, Versporten A, Muller A, Vankerckhoven V, Goossens H; ESAC Project Group (2011) European Surveillance of Antimicrobial Consumption (ESAC): quality appraisal of antibiotic use in Europe. J Antimicrob Chemother 66(Suppl 6):vi71–vi77. doi:10.1093/jac/dkr459

    Article  PubMed  CAS  Google Scholar 

  14. Ashworth M, Charlton J, Ballard K, Latinovic R, Gulliford M (2005) Variations in antibiotic prescribing and consultation rates for acute respiratory infection in UK general practices 1995–2000. Br J Gen Pract 55(517):603–608

    PubMed  Google Scholar 

  15. Altiner A, Wilm S, Wegscheider K, Sielk M, Brockmann S, Fuchs A, Abholz HH, In der Schmitten J (2010) Fluoroquinolones to treat uncomplicated acute cough in primary care: predictors for unjustified prescribing of antibiotics. J Antimicrob Chemother 65(7):1521–1525. doi:10.1093/jac/dkq151

    Article  PubMed  CAS  Google Scholar 

  16. Nathwani D, Sneddon J, Malcolm W, Wiuff C, Patton A, Hurding S, Eastaway A, Seaton RA, Watson E, Gillies E, Davey P, Bennie M; Scottish Antimicrobial Prescribing Group (2011) Scottish Antimicrobial Prescribing Group (SAPG): development and impact of the Scottish National Antimicrobial Stewardship Programme. Int J Antimicrob Agents 38(1):16–26. doi:10.1016/j.ijantimicag.2011.02.005

    Article  PubMed  CAS  Google Scholar 

  17. AFSSAPS (Agence française de sécurité sanitaire des produits de santé) (2008) AFSSAPS Practice recommendations for diagnosis and antibiotic therapy of adult community urinary tract infections. Med Mal Infect 38(Suppl 3):S203–S252

    Google Scholar 

  18. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM Jr, Musher DM, Niederman MS, Torres A, Whitney CG; Infectious Diseases Society of America; American Thoracic Society (2007) Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 44(Suppl 2):S27–S72. doi:10.1086/511159

    Article  PubMed  CAS  Google Scholar 

  19. van der Starre WE, van Nieuwkoop C, Paltansing S, van’t Wout JW, Groeneveld GH, Becker MJ, Koster T, Wattel-Louis GH, Delfos NM, Ablij HC, Leyten EM, Blom JW, van Dissel JT (2011) Risk factors for fluoroquinolone-resistant Escherichia coli in adults with community-onset febrile urinary tract infection. J Antimicrob Chemother 66(3):650–656. doi:10.1093/jac/dkq465

    Article  PubMed  Google Scholar 

  20. Arslan H, Azap OK, Ergönül O, Timurkaynak F; Urinary Tract Infection Study Group (2005) Risk factors for ciprofloxacin resistance among Escherichia coli strains isolated from community-acquired urinary tract infections in Turkey. J Antimicrob Chemother 56(5):914–918. doi:10.1093/jac/dki344

    Article  PubMed  CAS  Google Scholar 

  21. Killgore KM, March KL, Guglielmo BJ (2004) Risk factors for community-acquired ciprofloxacin-resistant Escherichia coli urinary tract infection. Ann Pharmacother 38(7–8):1148–1152. doi:10.1345/aph.1D622

    Article  PubMed  CAS  Google Scholar 

  22. Lin CY, Huang SH, Chen TC, Lu PL, Lin WR, Chen YH (2008) Risk factors of ciprofloxacin resistance in urinary Escherichia coli isolates. J Microbiol Immunol Infect 41(4):325–331

    PubMed  CAS  Google Scholar 

  23. Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, Moran GJ, Nicolle LE, Raz R, Schaeffer AJ, Soper DE; Infectious Diseases Society of America; European Society for Microbiology and Infectious Diseases (2011) International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis 52(5):e103–e120. doi:10.1093/cid/ciq257

    Article  PubMed  Google Scholar 

  24. Klossek JM, Chidiac C, Serrano E, Gehanno P, Naudé P, Amsellem J, Dubreuil C, Ferrand PA, Jankowski R, May T, Bébéar C, Dubreuil L; Groupe d’Etude des Sinusites Infectieuses II (GESI II) (2005) Community-acquired acute maxillary sinusitis or rhinosinusitis in adults in France: current management. Presse Med 34(22 Pt 2):1755–1763

    Article  PubMed  Google Scholar 

  25. Woodhead M, Blasi F, Ewig S, Huchon G, Ieven M, Ortqvist A, Schaberg T, Torres A, van der Heijden G, Verheij TJ; European Respiratory Society; European Society of Clinical Microbiology and Infectious Diseases (2005) Guidelines for the management of adult lower respiratory tract infections. Eur Respir J 26(6):1138–1180. doi:10.1183/09031936.05.00055705

    Article  PubMed  CAS  Google Scholar 

  26. Rosenfeld RM, Andes D, Bhattacharyya N, Cheung D, Eisenberg S, Ganiats TG, Gelzer A, Hamilos D, Haydon RC 3rd, Hudgins PA, Jones S, Krouse HJ, Lee LH, Mahoney MC, Marple BF, Mitchell CJ, Nathan R, Shiffman RN, Smith TL, Witsell DL (2007) Clinical practice guideline: adult sinusitis. Otolaryngol Head Neck Surg 137(3 Suppl):S1–S31. doi:10.1016/j.otohns.2007.06.726

    Article  PubMed  Google Scholar 

  27. Fokkens W, Lund V, Mullol J; European Position Paper on Rhinosinusitis and Nasal Polyps group (2007) European position paper on rhinosinusitis and nasal polyps 2007. Rhinol Suppl 20:1–136

    PubMed  Google Scholar 

  28. Lim WS, Baudouin SV, George RC, Hill AT, Jamieson C, Le Jeune I, Macfarlane JT, Read RC, Roberts HJ, Levy ML, Wani M, Woodhead MA; Pneumonia Guidelines Committee of the BTS Standards of Care Committee (2009) BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax 64(Suppl 3):iii1–iii55. doi:10.1136/thx.2009.121434

    Article  PubMed  Google Scholar 

  29. Veyssier-Belot C, Lecomte F (2000) Consensus conference on erysipelas and necrotizing fasciitis, Tours, January 26, 2000. Rev Med Interne 21(8):655–658

    PubMed  CAS  Google Scholar 

  30. Shahmanesh M, Moi H, Lassau F, Janier M; IUSTI/WHO (2009) 2009 European guideline on the management of male non-gonococcal urethritis. Int J STD AIDS 20(7):458–464. doi:10.1258/ijsa.2009.009143

    Article  PubMed  CAS  Google Scholar 

  31. Ross JD; European Branch of the International Union against Sexually Transmitted Infection and the European Office of the World Health Organization (2001) European guideline for the management of pelvic inflammatory disease and perihepatitis. Int J STD AIDS 12(Suppl 3):84–87

    Article  PubMed  Google Scholar 

  32. Pulcini C, Mondain V, Lieutier F, Mousnier A, Roger PM, Dellamonica P (2007) Fluoroquinolone prescriptions in a teaching hospital: a prospective audit. Scand J Infect Dis 39(11–12):1013–1017. doi:10.1080/00365540701466223

    Article  PubMed  Google Scholar 

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Acknowledgements

To Steve Nauleau for providing the NHI database, to Patrick Kurkdji for calculating the DDDs and to Marie Jardin for her help with the database labels. Part of this work was presented as a poster at the 2012 French Infectious Diseases congress.

Author contributions

C.P. designed the study, wrote the protocol and the article. C.L. performed the statistical analysis and reviewed the article. B.V. and P.V. reviewed the study protocol and the article.

Conflict of interest

None declared.

Funding

The work of Céline Pulcini is supported by the “Infectiopôle Sud” foundation (a non profit-making institution, http://www.infectiopolesud.com/), which funds her accommodation and travel expenses when coming to Marseille. The funder had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript.

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Authors and Affiliations

  1. Service d’Infectiologie, Centre Hospitalier Universitaire de Nice, Hôpital l’Archet 1, 151 Route Saint Antoine de Ginestière, BP 3079, 06202, Nice Cedex 3, France

    C. Pulcini

  2. Université Nice-Sophia Antipolis, Faculté de Médecine de Nice, Nice, France

    C. Pulcini

  3. INSERM, U912 (SESSTIM), Marseille, France

    C. Pulcini, C. Lions, B. Ventelou & P. Verger

  4. Aix-Marseille University, IRD, UMR-S912, Marseille, France

    C. Lions, B. Ventelou & P. Verger

  5. ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France

    C. Lions, B. Ventelou & P. Verger

  6. CNRS, U6579 (greqam), Marseille, France

    B. Ventelou

Authors
  1. C. Pulcini
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  2. C. Lions
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  4. P. Verger
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Correspondence to C. Pulcini.

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Pulcini, C., Lions, C., Ventelou, B. et al. Approaching the quality of antibiotic prescriptions in primary care using reimbursement data. Eur J Clin Microbiol Infect Dis 32, 325–332 (2013). https://doi.org/10.1007/s10096-012-1743-2

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  • DOI: https://doi.org/10.1007/s10096-012-1743-2

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