Skip to main content

Effect of intervention promoting a reduction in antibiotic prescribing by improvement of diagnostic procedures: a prospective, before and after study in general practice

European Journal of Clinical Pharmacology volume 62, Article number: 913 (2006) Cite this article

Abstract

Objective

To investigate if an intervention aimed at improving the quality of the diagnostic procedures in Spanish general practice could lower antibiotic prescribing in patients with respiratory tract infections (RTIs).

Methods

GPs in the intervention group (n=17) registered all patients with RTIs during a 3-week period before and after the intervention. The intervention was aimed at reducing prescribing of inappropriate antibiotics for RTIs by improving the diagnostic procedures and thereby helping the GPs to distinguish between bacterial and viral infections. It consisted of courses in management of RTI according to local clinical guidelines, and included implementation of two rapid diagnostic tests (StrepA and CRP measurement). Diagnoses and prescribing of antibiotics were assessed before and after the intervention, and compared to a control group not exposed to intervention (35 GPs).

Results

The intervention led to a significant reduction in antibiotic prescribing. Before the intervention 36% (29%–44%) of consultations were followed by antibiotic prescribing, after the intervention 24% (20%–29%). Antibiotic prescribing in the control group not exposed to intervention was 32% (27%–38%). The reduction was most pronounced in patients with sinusitis and lower RTIs.

Conclusion

Quality improvement of diagnostic procedures may lead to a reduction of antibiotic prescribing in primary health care in Spain.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Report of the ASM task force on antibiotic resistance (1995) Antimicrob Agents Chemother 39:(Suppl):1–23

    Google Scholar 

  2. Bronzwaer SL, Cars O, Buchholz U, Molstad S, Goettsch W, Veldhuijzen IK et al (2002) A European study on the relationship between antimicrobial use and antimicrobial resistance. Emerg Infect Dis 8:278–282

    PubMed  Article  Google Scholar 

  3. Pradier C, Dunais B, Carsenti-Etesse H, Dellamonica P (1997) Pneumococcal resistance patterns in Europe. Eur J Clin Microbiol Infect Dis 16:644–647

    PubMed  CAS  Article  Google Scholar 

  4. Picazo JJ, Perez-Cecilia E, Herreras A (2003) Respiratory infections outside the hospital. DIRA study. Enferm Infecc Microbiol Clin 21:410–416

    PubMed  Article  Google Scholar 

  5. Llor C, Bayona C (2004) Spanish primary healthcare physicians’ knowledge of resistance of respiratory germs and antimicrobial treatment in acute bronchitis. Eur J Gen Pract 10:88–92

    PubMed  Article  Google Scholar 

  6. Munck A, Damsgaard J, Hansen DG, Bjerrum L, Søndergaard J (2003) The Nordic method for quality improvement in general practice. Quality in Primary Care 11:73–78

    Google Scholar 

  7. Lindbaek M, Hoiby EA, Lermark G, Steinsholt IM, Hjortdahl P (2004) Which is the best method to trace group A streptococci in sore throat patients: culture or GAS antigen test? Scand J Prim Health Care 22:233–238

    PubMed  Article  Google Scholar 

  8. Hopstaken RM, Muris JW, Knottnerus JA, Kester AD, Rinkens PE, Dinant GJ (2003) Contributions of symptoms, signs, erythrocyte sedimentation rate, and C-reactive protein to a diagnosis of pneumonia in acute lower respiratory tract infection. Br J Gen Pract 53:358–364

    PubMed  CAS  Google Scholar 

  9. Melbye H, Aaraas I, Fleten N, Kolstrup N, Mikalsen JI (1995) The value of C-reactive protein testing in suspected lower respiratory tract infections. A study from general practice on the effect of a rapid test on antibiotic research and course of the disease in adults. Tidsskr Nor Laegeforen 115:1610–1615

    PubMed  CAS  Google Scholar 

  10. Diederichsen HZ, Skamling M, Diederichsen A, Grinsted P, Antonsen S, Petersen PH et al (2000) Randomised controlled trial of CRP rapid test as a guide to treatment of respiratory infections in general practice. Scand J Prim Health Care 18:39–43

    PubMed  CAS  Article  Google Scholar 

  11. van der Meer V, Neven AK, van den Broek PJ, Assendelft WJ (2005) Diagnostic value of C reactive protein in infections of the lower respiratory tract: systematic review. BMJ 331:26

    PubMed  Article  Google Scholar 

  12. Bjerrum L, Gahrn-Hansen B, Munck AP (2004) C-reactive protein measurement in general practice may lead to lower antibiotic prescribing for sinusitis. Br J Gen Pract 54:659–662

    PubMed  Google Scholar 

  13. Anonymous. Guidelines for ATC classification and DDD assignment. http://www.who.int/classifications/atcddd/en/

  14. Bentzen N. International Classification for Primary Care. http://www.globalfamilydoctor.com/WICC/

  15. Stata Press. Stata for windows (1999) Texas: Stata Statistical Software

  16. Lervy B, Wareham K, Cheung WY (1994) Practice characteristics associated with audit activity: a medical audit advisory group survey. Br J Gen Pract 44:311–314

    PubMed  CAS  Google Scholar 

  17. Munck A (1995) Audit Project Odense (APO)-A Scandinavian Audit Centre for General Practice. Audit Trends 3:18–21

    Google Scholar 

  18. Bremon AR, Ruiz-Tovar M, Gorricho BP, de Torres PD, Rodriguez RL (2000) Non-hospital consumption of antibiotics in Spain: 1987–1997. J Antimicrob Chemother 45:395–400

    PubMed  CAS  Article  Google Scholar 

  19. Contopoulos-Ioannidis DG, Koliofoti ID, Koutroumpa IC, Giannakakis IA, Ioannidis JP (2001) Pathways for inappropriate dispensing of antibiotics for rhinosinusitis: a randomized trial. Clin Infect Dis 33:76–82

    PubMed  CAS  Article  Google Scholar 

  20. Howie JG (1976) Clinical judgement and antibiotic use in general practice. BMJ 2:1061–1064

    PubMed  CAS  Article  Google Scholar 

  21. Bjerrum L, Boada A, Cots JM, Llor C, Fores GD, Gahrn-Hansen B et al (2004) Respiratory tract infections in general practice: considerable differences in prescribing habits between general practitioners in Denmark and Spain. Eur J Clin Pharmacol 60:23–28

    PubMed  Article  Google Scholar 

  22. Llor C, Bjerrum L (2005) Background for different use of antibiotics in different countries. Clin Infect Dis 40:333

    PubMed  Article  Google Scholar 

  23. Miravitlles M, Mayordomo C, Artes M, Sanchez-Agudo L, Nicolau F, Segu JL (1999) Treatment of chronic obstructive pulmonary disease and its exacerbations in general practice. EOLO Group. Estudio Observacional de la Limitacion Obstructiva al Flujo Aereo. Respir Med 93:173–179

    PubMed  CAS  Article  Google Scholar 

  24. Ochoa C, Inglada L, Eiros JM, Solis G, Vallano A, Guerra L (2001) Appropriateness of antibiotic prescriptions in community-acquired acute pediatric respiratory infections in Spanish emergency rooms. Pediatr Infect Dis J 20:751–758

    PubMed  CAS  Google Scholar 

Download references

Acknowledgement

The authors wish to thank the general practitioners in Spain for their participation in the study.

Author information

Affiliations

  1. Research Unit for General Practice, University of Southern Denmark, J. B. Winsløws Vej 9 A, DK-5000, Odense C, Denmark

    Lars Bjerrum

  2. Catalan Society of Family Medicine, Barcelona, Spain

    Josep M. Cots, Carl Llor & Núria Molist

  3. Audit Project Odense, Research Unit for General Practice, University of Southern Denmark, Odense C, Denmark

    Anders Munck

Authors
  1. Lars Bjerrum
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Josep M. Cots
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carl Llor
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Núria Molist
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anders Munck
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lars Bjerrum.

Additional information

Contributors: LB participated in the intervention, performed the analysis and wrote the manuscript. JMC participated in intervention, collected data, and revised the paper. CL participated in intervention, collected data and revised the paper. NM participated in intervention, collected data and revised the paper, AM conceived the method and extensively revised the paper.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Bjerrum, L., Cots, J.M., Llor, C. et al. Effect of intervention promoting a reduction in antibiotic prescribing by improvement of diagnostic procedures: a prospective, before and after study in general practice. Eur J Clin Pharmacol 62, 913 (2006). https://doi.org/10.1007/s00228-006-0187-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00228-006-0187-y

Keywords

  • Antibiotics
  • General practice
  • Intervention
  • Diagnostic procedures
  • Respiratory tract infections