Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Nov;46(9):492-500.
doi: 10.1016/j.aprim.2014.02.006. Epub 2014 Apr 24.

Effectiveness of two types of intervention on antibiotic prescribing in respiratory tract infections in Primary Care in Spain. Happy Audit Study

Carles Llor  1 , Josep Maria Cots  2 , Silvia Hernández  3 , Jesús Ortega  4 , Javier Arranz  5 , María José Monedero  6 , Juan de Dios Alcántara  7 , Carolina Pérez  8 , Guillermo García  9 , Manuel Gómez  10 , Gloria Guerra  11 , Marina Cid  12 , María Luisa Cigüenza  13 , Vicenta Pineda  14 , José Paredes  15 , Juan Luis Burgazzoli  16 , Anders Munck  17 , Gloria Cordoba-Currea  18 , Lars Bjerrum  18 ; Happy Audit Study Group
Collaborators, Affiliations

Effectiveness of two types of intervention on antibiotic prescribing in respiratory tract infections in Primary Care in Spain. Happy Audit Study

Carles Llor et al. Aten Primaria. 2014 Nov.

Abstract
in English, Spanish

Objective: To evaluate the effectiveness of two types of intervention in reducing antibiotic prescribing in respiratory tract infections (RTI).

Design: Before-after audit-based study.

Setting: Primary Care centres in Spain.

Participants: General practitioners (GPs) registered all patients with RTIs for 15 days in winter 2008 (pre-intervention), and again in winter 2009 (post-intervention).

Interventions: Intervention activities included meetings, with the presentation and discussion of the results, and several training meetings on RTI guidelines, information brochures for patients, workshops on point-of-care tests - rapid antigen detection tests and C-reactive protein rapid test - and provision of these tests in the clinic. All GPs, with the exception of those in Catalonia, made up the full intervention group (FIG); conversely, Catalan doctors underwent the same intervention, except for the workshop on rapid tests (partial intervention group, PIG). Multilevel logistic regression was performed taking the prescription of antibiotics as the dependent variable.

Results: Out of a total of 309 GPs involved in the first register, 281 completed the intervention and the second register (90.9%), of which 210 were assigned to the FIG, and 71 to the PIG. The odds ratio of antibiotic prescribing after the intervention was 0.99 (95% CI: 0.89-1.10) among GPs assigned to PIG, and 0.50 (95% CI: 0.44-0.57, p<0.001) among those who were allocated to FIG. The reduction in antibiotic prescribing in FIG was more marked in flu infection, common cold, acute pharyngitis, acute tonsillitis, and acute bronchitis.

Conclusions: Active participation of GPs with the performance of point-of-care tests in the clinic is accompanied by a drastic reduction of antibiotic use in RTIs, primarily in infections considered as mainly viral.

Objetivo: Evaluar la efectividad de dos tipos de intervención en la prescripción antibiótica en infecciones del tracto respiratorio (ITR).

Diseño: Estudio antes-después basado en audit.

Emplazamiento: Centros de atención primaria de España.

Participantes: Médicos de familia registraron durante 15 días en invierno 2008 todas las ITR (preintervención), que se repitió en 2009 (postintervención).

Intervenciones: Se realizaron reuniones con presentación y discusión de resultados, sesiones de formación en guías de ITR, folletos informativos para pacientes, talleres en uso de pruebas rápidas (Strep A y proteína C reactiva) y su provisión en las consultas. Los médicos participantes a excepción de Cataluña realizaron la intervención completa (IC), mientras que los médicos de Cataluña realizaron lo mismo menos el taller de pruebas rápidas (intervención parcial [IP]). Se efectuó análisis de regresión logística multinivel considerando como variable dependiente la prescripción antibiótica.

Resultados: De los 309 médicos que realizaron el primer registro, 281 completaron la intervención y el segundo registro (90,9%), de los cuales 210 se asignaron a IC y 71 a IP. La odds ratio de prescripción antibiótica después de la intervención fue de 0.99 (IC95%: 0,89–1,10) entre los médicos asignados a IP, mientras que el observado en la IC fue de 0.50 (IC95%: 0,44–0,57, p < 0,001). La mayor reducción de prescripción antibiótica en IC se observó en gripe, catarro común, faringitis aguda, amigdalitis aguda y bronquitis aguda.

Conclusiones: La participación activa de los médicos con uso de pruebas rápidas en la consulta se acompaña de una reducción importante de antibióticos en las ITR, sobre todo en las infecciones mayoritariamente virales.

Keywords: Antibiotics; Antibióticos; Audit; Infecciones del tracto respiratorio; Intervención; Intervention; Point-of-care test; Pruebas rápidas; Respiratory tract infections.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Template used to register the respiratory tract infections (English version).
Figure 2
Figure 2
General scheme of the study.
Figure 3
Figure 3
Use of rapid tests and request for X-ray by GPs in the different groups after the intervention.
Figure 4
Figure 4
Percentage of antibiotic prescribing in the full intervention group depending on whether the GPs used the point-of-care tests.
See this image and copyright information in PMC

References

    1. Llor C., Hernández S. Enfermedad infecciosa en atención primaria: estudio prospectivo efectuado durante todo un año. Enferm Infecc Microbiol Clin. 2010;28:222–226. - PubMed
    1. Mauldin P.D., Salgado C.D., Hansen I.S., Durup D.T., Bosso J.A. Attributable hospital cost and length of stay associated with health care-associated infections caused by antibiotic resistant gram-negative bacteria. Antimicrob Agents Chemother. 2010;54:109–115. - PMC - PubMed
    1. Roberts R.R., Hota B., Ahmad I., Scott R.D., Foster S.D., Abbasi F. Hospital and societal costs of antimicrobial-resistant infections in a Chicago teaching hospital: implications for antibiotic stewardship. Clin Infect Dis. 2009;49:1175–1184. - PubMed
    1. Goossens H., Ferech M., Vander Stichele R., Elseviers M., ESAC Project Group Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 2005;365:579–587. - PubMed
    1. McNulty C.A. Optimising antibiotic prescribing in primary care. Int J Antimicrob Agents. 2001;18:329–333. - PubMed

Publication types

MeSH terms

Substances