Research article

BMC Family Practice

, 12:52

Open Access This content is freely available online to anyone, anywhere at any time.

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

  • Lars BjerrumAffiliated withResearch Unit for General Practice and Section of General Practice, Department of Public Health, University of CopenhagenResearch Unit of General Practice, Institute of Public Health, University of Southern Denmark Email author 
  • , Anders MunckAffiliated withResearch Unit of General Practice, Institute of Public Health, University of Southern Denmark
  • , Bente Gahrn-HansenAffiliated withResearch Unit of General Practice, Institute of Public Health, University of Southern Denmark
  • , Malene Plejdrup HansenAffiliated withResearch Unit of General Practice, Institute of Public Health, University of Southern Denmark
  • , Dorte Ejg JarbolAffiliated withResearch Unit of General Practice, Institute of Public Health, University of Southern Denmark
  • , Gloria CordobaAffiliated withResearch Unit of General Practice, Institute of Public Health, University of Southern Denmark
  • , Carl LlorAffiliated withSpanish Society of Family Medicine
  • , Josep Maria CotsAffiliated withSpanish Society of Family Medicine
  • , Silvia HernándezAffiliated withSpanish Society of Family Medicine
    • , Beatriz González López-ValcárcelAffiliated withUniversity of Las Palmas
    • , Antonia PérezAffiliated withUniversity of Las Palmas
    • , Lidia CaballeroAffiliated withMisiones Association of General Family Medicine
    • , Walter von der HeydeAffiliated withMisiones Association of General Family Medicine
    • , Ruta RadzevicieneAffiliated withPublic Health Department, Faculty of Health Sciences, Klaipeda University
    • , Arnoldas JurgutisAffiliated withPublic Health Department, Faculty of Health Sciences, Klaipeda University
    • , Anatoliy ReutskiyAffiliated withAssociation of Family Doctors
    • , Elena EgorovaAffiliated withAssociation of Family Doctors
    • , Eva Lena StrandbergAffiliated withDepartment of Clinical Sciences, Lund University
    • , Ingvar OvhedAffiliated withDepartment of Clinical Sciences, Lund University
    • , Sigvard MölstadAffiliated withDepartment of Clinical Sciences, Lund University
    • , Vander Robert SticheleAffiliated withEuropean Drug Utilisation Research Group
    • , Ria BenkoAffiliated withEuropean Drug Utilisation Research Group
    • , Vera Vlahovic-PalcevskiAffiliated withEuropean Drug Utilisation Research Group
    • , Christos LionisAffiliated withWorld Organisation of Family Doctors (WONCA) Europe
    • , Marit RønningAffiliated withWorld Health Organisation, Collaborating Centre for Drug Statistics Methodology

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.