. 2025 Feb 7;42(2):cmae064.

doi: 10.1093/fampra/cmae064.

Impact of a multifaceted intervention programme on antibiotic prescribing and dispensing in four patient-centred settings in five European countries. The HAPPY PATIENT project

Ana García-Sangenís^{1

2}, Jesper Lykkegaard³, Malene Plejdrup Hansen^{3

4}, Beatriz González López-Valcárcel⁵, Fabiana Raynal⁵, Laura Vallejo-Torres⁵, Lars Bjerrum⁶, Athina Chalkidou^{6

7}, Jette Nygaard Jensen⁷, Ingrid Rebnord⁸, Bent Håkan Lindberg^{8

9}, Katja Taxis¹⁰, Maarten Lambert¹⁰, Ruta Radzeviciene¹¹, Lina Jaruseviciene¹², Pia Touboul Lundgren¹³, Pascale Bruno¹³, Vanessa Lesage¹³, Anna Kowalczyk¹⁴, Maciej Godycki-Cwirko¹⁴, Christos Lionis¹⁵, Maria-Nefeli Karkana¹⁵, Marilena Anastasaki¹⁵, Matilde Bøgelund Hansen⁷, Jonas Kanstrup Olsen³, Jens Søndergaard³, Daniela Modena¹, Stella Mally¹, Laura Álvarez¹⁶, Carl Llor^{2

3

17}

Affiliations

¹ Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol, Gran Via de les Corts Catalanes, 587 àtic, 08007, Barcelona, Catalonia, Spain.
² CIBER Enfermedades Infecciosas, Instituto de la Salud Carlos III, c. Sinesio Delgado 10, 28029, Madrid, Spain.
³ Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Campusvej 55, DK-5030, Odense, Funen, Denmark.
⁴ Research Unit for General Practice, Center for General Practice, Aalborg University, Fyrkildevej 79, 9220, Aalborg, Jutland, Denmark.
⁵ Quantitative Methods for Economics and Management, University of Las Palmas de Gran Canaria, Juan de Quesada, 30, 35001, Las Palmas de Gran Canaria, Canary Islands, Spain.
⁶ Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade, 51014, Copenhagen, Zealand, Denmark.
⁷ Department of Clinical Microbiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej, 18A, 2900, Hellerup, Zealand, Denmark.
⁸ NORCE Norwegian Research Centre AS, Nygårtsgaten, 122, 5008, Bergen, Norway.
⁹ Department of General Practice, Inst. of Health and Society, University of Oslo, Kirkeveien, 166, 0450, Oslo, Norway.
¹⁰ Unit of Pharmacotherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Antonius Deusinglaan, 1, 9700, Groningen, The Netherlands.
¹¹ Ltd Mano Seimos Gydytojas (My Family Doctor), Taikos, 119, 94231, Klapéida, Lithuania.
¹² Department of Family Medicine, Lithuanian University of Health Sciences, Eiveniu, 25-0009, Kaunas, Lithuania.
¹³ Department of Public Health, Nice University Hospital, voie Roman, 30, 06001, Nice, France.
¹⁴ Faculty of Health Sciences, Centre for Family and Community Medicine, Medical University of Lodz, Pl. Generala Józefa Hallera, 19, 0647, Lodz, Poland.
¹⁵ Clinic of Social and Family Medicine, School of Medicine, University of Crete, Pros Voutes, 70070003, Heraklion, Crete, Greece.
¹⁶ Spanish Society for Family and Community Medicine, Diputació, 320, baixos, 08009, Barcelona, Catalonia, Spain.
¹⁷ Via Roma Health Centre, Institut Català de la Salut, Balmes, 22, 08006, Barcelona, Catalonia, Spain.

PMID: 39531344
PMCID: PMC11809241
DOI: 10.1093/fampra/cmae064

Impact of a multifaceted intervention programme on antibiotic prescribing and dispensing in four patient-centred settings in five European countries. The HAPPY PATIENT project

Ana García-Sangenís et al. Fam Pract. 2025.

. 2025 Feb 7;42(2):cmae064.

doi: 10.1093/fampra/cmae064.

Authors

Affiliations

¹ Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol, Gran Via de les Corts Catalanes, 587 àtic, 08007, Barcelona, Catalonia, Spain.
² CIBER Enfermedades Infecciosas, Instituto de la Salud Carlos III, c. Sinesio Delgado 10, 28029, Madrid, Spain.
³ Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Campusvej 55, DK-5030, Odense, Funen, Denmark.
⁴ Research Unit for General Practice, Center for General Practice, Aalborg University, Fyrkildevej 79, 9220, Aalborg, Jutland, Denmark.
⁵ Quantitative Methods for Economics and Management, University of Las Palmas de Gran Canaria, Juan de Quesada, 30, 35001, Las Palmas de Gran Canaria, Canary Islands, Spain.
⁶ Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade, 51014, Copenhagen, Zealand, Denmark.
⁷ Department of Clinical Microbiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej, 18A, 2900, Hellerup, Zealand, Denmark.
⁸ NORCE Norwegian Research Centre AS, Nygårtsgaten, 122, 5008, Bergen, Norway.
⁹ Department of General Practice, Inst. of Health and Society, University of Oslo, Kirkeveien, 166, 0450, Oslo, Norway.
¹⁰ Unit of Pharmacotherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Antonius Deusinglaan, 1, 9700, Groningen, The Netherlands.
¹¹ Ltd Mano Seimos Gydytojas (My Family Doctor), Taikos, 119, 94231, Klapéida, Lithuania.
¹² Department of Family Medicine, Lithuanian University of Health Sciences, Eiveniu, 25-0009, Kaunas, Lithuania.
¹³ Department of Public Health, Nice University Hospital, voie Roman, 30, 06001, Nice, France.
¹⁴ Faculty of Health Sciences, Centre for Family and Community Medicine, Medical University of Lodz, Pl. Generala Józefa Hallera, 19, 0647, Lodz, Poland.
¹⁵ Clinic of Social and Family Medicine, School of Medicine, University of Crete, Pros Voutes, 70070003, Heraklion, Crete, Greece.
¹⁶ Spanish Society for Family and Community Medicine, Diputació, 320, baixos, 08009, Barcelona, Catalonia, Spain.
¹⁷ Via Roma Health Centre, Institut Català de la Salut, Balmes, 22, 08006, Barcelona, Catalonia, Spain.

PMID: 39531344
PMCID: PMC11809241
DOI: 10.1093/fampra/cmae064

Abstract

Background: The primary cause of antimicrobial resistance is excessive and non-indicated antibiotic use.

Aim: To evaluate the impact of a multifaceted intervention aimed at various healthcare professionals (HCPs) on antibiotic prescribing and dispensing for common infections.

Design and setting: Before-and-after study set in general practice, out-of-hours services, nursing homes, and community pharmacies in France, Greece, Lithuania, Poland, and Spain.

Methods: Following the Audit Project Odense method, HCPs from these four settings self-registered encounters with patients related to antibiotic prescribing and dispensing before and after an intervention (February-April 2022 and February-April 2023). Prior to the second registration, the HCPs undertook a multifaceted intervention, which included reviewing and discussing feedback on the first registration's results, enhancing communication skills, and providing communication tools. Indicators to identify potentially unnecessary prescriptions and non-first-line antibiotic choices were developed, and the results of the two registrations were compared.

Results: A total of 345 HCPs registered 10 744 infections in the first registration period and 10 207 infections in the second period. In general practice, participants showed a significant 9.8% reduction in unnecessary antibiotic prescriptions in the second period, whereas limited or no effect was observed in out-of-hours services and nursing homes (0.8% reduction and 4.5% increase, respectively). Pharmacies demonstrated an 18% increase in safety checks, and correct advice in pharmacies rose by 17%.

Conclusion: External factors like COVID-19, antibiotic shortages, and a streptococcal epidemic impacted the intervention's benefits. Despite this, the intervention successfully improved antibiotic use in both settings.

Keywords: after-hours care; anti-bacterial agents; antimicrobial stewardship; medical audit; nursing homes; pharmacies; primary healthcare.

PubMed Disclaimer

Conflict of interest statement

J.S. reports fees from Abbott Rapid Diagnostics A/S, Roche Diagnostics A/S, Roche a/s, NovoNordisk a/s, and is member of the board of Steno Diabetes Center, Odense. All other authors declare no competing interests.

References

1. Dadgostar P. Antimicrobial resistance: implications and costs. Infect Drug Resist 2019;12:3903–10. 10.2147/IDR.S234610 - DOI - PMC - PubMed
1. Bruyndonckx R, Hoxha A, Quinten C, et al.; ESAC-Net study group. Change-points in antibiotic consumption in the community, European Union/European Economic Area, 1997-2017. J Antimicrob Chemother 2021;76:ii68–78. 10.1093/jac/dkab179 - DOI - PMC - PubMed
1. Health Emergency Preparedness and Response Authority. HEALTH UNION: Identifying Top 3 Priority Health Threats, 2022. https://health.ec.europa.eu/system/files/2022-07/hera_factsheet_health-t...(4 November 2024, date last accessed).
1. Fleming-Dutra KE, Hersh AL, Shapiro DJ, et al.Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011. J Am Med Assoc 2016;315:1864–73. 10.1001/jama.2016.4151 - DOI - PubMed
1. ECDC, European Commission. EU Guidelines for the Prudent Use of Antimicrobials in Human Health. https://www.ecdc.europa.eu/en/publications-data/proposals-eu-guidelines-... (4 November 2024, date last accessed). - PubMed

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Substances

Actions

Grants and funding

900024/European Union's Third Health Programme (2014-2020)

LinkOut - more resources

Full Text Sources
Medical
- MedlinePlus Health Information
Miscellaneous
- NCI CPTAC Assay Portal

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Impact of a multifaceted intervention programme on antibiotic prescribing and dispensing in four patient-centred settings in five European countries. The HAPPY PATIENT project

Affiliations

Impact of a multifaceted intervention programme on antibiotic prescribing and dispensing in four patient-centred settings in five European countries. The HAPPY PATIENT project

Authors

Affiliations

Abstract

Conflict of interest statement

References

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous