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ARTI 4 Understanding and Optimising Antibiotic Prescribing in Primary Care - 4 successive projects in the Netherlands Alike van der Velden Marijke Kuyvenhoven.

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Presentation on theme: "ARTI 4 Understanding and Optimising Antibiotic Prescribing in Primary Care - 4 successive projects in the Netherlands Alike van der Velden Marijke Kuyvenhoven."— Presentation transcript:

1 ARTI 4 Understanding and Optimising Antibiotic Prescribing in Primary Care - 4 successive projects in the Netherlands Alike van der Velden Marijke Kuyvenhoven Theo Verheij Julius Center for Health Sciences and Primary Care University Medical Center Utrecht The Netherlands

2 ARTI (Antibiotics and Respiratory Tract Infections): linking academia to primary care practice

3 Antibiotics and Respiratory Tract Infections RTIs : acute otitis media sinusitis, cold sore throat (tonsillitis, laryngitis) acute cough (bronchitis, pneumonia)  Mostly viral and self-limiting  Effects of antibiotics are limited  Over-prescription of antibiotics resistance patients’ re-consultation unnecessary exposure to adverse effects unnecessary costs

4 Antibiotics in The Netherlands  Comparatively low antibiotic consumption (coinciding with low resistance) 450 treatments / 1000 inhabitants / year France: x3, Greece: x5  No OTC selling  80% is prescribed by general practitioners ► 4 primary care guidelines for treatment of RTIs antibiotics indicated for patients: with a severe RTI with risks of complications (suspected of) pneumonia

5 How does it work in daily practice? time pressure diagnostic uncertainty patients demanding for antibiotics Friday afternoons GPs’ habits GP-patient relationship

6 ARTI 1: insight in antibiotic prescribing Methods: detailed analysis of 2800 consultations for RTIs

7 ARTI 1: Results Antibiotic prescription for RTIs: 37% of consultations prescriptionover-prescription OMA47%5% sore throat30%58% sinusitis, cold35%53% acute cough38%48%  44% of prescriptions are not according to the guidelines: over-prescription is ▪ highest for tonsillitis and bronchitis ▪ associated with- inflammations signs - patients’ wish for an antibiotic

8 ARTI 2 and 3: interventions to optimise antibiotic prescribing ARTI 2: RCT intervention:▪ education GPs (practice level) guidelines, literature, communication ▪ monitoring/feedback prescribing data and behaviour ▪ information material patients outcome: -12% in antibiotic prescribing rate ARTI 3: CBA similar intervention:▪ education to larger groups of GPs ▪ monitoring/feedback prescribing data outcome: no reduction in number of antibiotic prescriptions

9 Implementation: ARTI 4 Antibiotic prescribing practice can be improved Barriers in implementation:- commitment of physicians - sustainability of the effect  embedment within a regular quality assurance cycle: practice accreditation* of the Dutch College of General Practitioners * improving quality in care and organisational structure of primary care practices 3 years cycle:- yearly audit - practice organisation - prescribing routines - chronic disease management - yearly ‘improvement plans’

10 ARTI 4: support and a ready-to-use plan optimising Ab prescription for RTIs reducing (chronic) use of PPIs ARTI 4: Study set-up (I) RCT with 87 primary care practices (1-7 GPs / practice) Ab and PPI practices serve as each others controls Primary outcomes: Antibiotics:Ab prescriptions / 1000 pnts / year % 2 nd choice prescriptions J01 collected via pharmacies Secondary outcomes and feed-back supplied to practices: Antibiotics:prescribing behaviour 4-weeks registration of RTIs Data collection: 1 year preceding intervention, at year 1 and 2

11 ARTI 4 study set-up (II) Multiple intervention educational meeting GPs at practice level - guidelines, literature - feedback on prescription data / behaviour - communication, patients’ pressure  improvement plan practice-specific definition of targets meanrange Ab/1000 pnt/year % 2 nd choice 28%19% - 43% over-prescription 44% 0% - 67% base-line data

12 Feedback ‘Antibiotics’ during education guidelineprescribeconsiderno Ab prescribed17 not prescribed31 OMA Sore throat Sinusitis guidelineprescribeno Ab prescribed32* not prescribed12 guidelineconsiderno Ab prescribed66* not prescribed26 guidelineprescribeno Ab prescribed87* not prescribed17 Cough

13 Feedback ‘Antibiotics’ after 1 year

14 ARTI 4: intervention effect on antibiotic prescription (n=49) Intervention: Ab (n=25) Control: PPI (n=24) p= % change RTI Ab prescrip/1000 pat (-33 – 12) -3.3 (-21 – 29) 0.03 % change 2 nd choice prescrip/1000 pat (-56 – 31) +0.9 (-30 – 48) 0.03  ARTI4 intervention significantly reduces antibiotic prescription Goals and future plans: long-term effectiveness of this intervention (2 years) development of internet-based educational programs

15 Questions? Acknowledgements: All Dutch general practitioners involved in one of the projects


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