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

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.

[Antibiotic prescribing in respiratory tract infections and predictive factors for their use]. / Prescripción de antibióticos en las infecciones del tracto respiratorio y factores predictores de su utilización.

OBJECTIVE: Happy Audit project is a European-funded survey aimed at reducing antibiotic prescribing for respiratory tract infections (RTI). The aim of this study is to investigate the antibiotic treatment administered for these RTIs in Spain and to find out which criteria are associated with its use. DESIGN: Cross-sectional study carried out in January and February 2008. SETTING: Primary health care. PARTICIPANTS: General practitioners registered all the RTI during a 3-week period using a template. PRINCIPAL MEASUREMENTS: Age and gender, days with symptoms, signs presented (fever, cough, purulent ear discharge, sore throat, tonsillar exudate, swollen neck glands, dyspnoea, increase in sputum, purulent sputum), diagnosis, antibiotic therapy and demand of antibiotics. A logistic regression with the prescription of antibiotic as the dependent variable was performed. RESULTS: Out of the 332 physicians invited to participate, 309 filled in and returned the templates (93.1%), registering 16,751 RTIs, with the common cold (39.7%), pharyngitis (14.4%) and acute bronchitis (12.6%) being the most common. Antibiotic therapy was given to 4,675 RTIs (27.9%), mainly for pneumonia (89.9%), tonsillitis (88.9%), and otitis media (87.3%). The criterion most associated with antibiotic therapy was the presence of tonsillar exudate (OR: 32.1; 95CI%: 24.5-42), followed by ear discharge (25.2; 95%CI: 18.2-35) and purulence of sputum (18.1; 95%CI: 15.5-21.2); conversely, cough (OR: 0.4; 95%CI: 0.3-0.5) was considered as protective factor. DISCUSSION: Antibiotic treatment for RTIs is very high in our country. This study provides information on the criteria that predict this antibiotic therapy and is important to take into account if a more rational use of antibiotics is required.

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

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

Prescripción de antibióticos en las infecciones del tracto respiratorio y factores predictores de su utilización / Antibiotic prescribing in respiratory tract infections and predictive factors for their use

ObjetivoEl estudio Happy Audit es un proyecto financiado por la Comunidad Europea, y tiene por objetivo mejorar la prescripción antibiótica en las infecciones del tracto respiratorio (ITR). Se realizó el presente estudio para conocer el tratamiento antibiótico administrado en las ITR en España y conocer qué criterios se asocian a su prescripción.DiseñoEstudio transversal realizado en enero y febrero de 2008.EmplazamientoCentros de atención primaria.ParticipantesMédicos de atención primaria de España que registraron durante 3 semanas todas las ITR mediante una plantilla.Mediciones principalesEdad y sexo, días con síntomas, signos presentes (fiebre, tos, otorrea purulenta, odinofagia, exudado amigdalar, adenopatías cervicales, disnea, aumento de esputo, esputo purulento), diagnóstico, tratamiento antibiótico y demanda de antibiótico. Se efectuó regresión logística y se consideró como variable dependiente la prescripción antibiótica.ResultadosDe los 332 médicos a los que se invitó a participar, 309 (93,1%) rellenaron los registros. Se registraron 16.751 ITR; las más frecuentes fueron el resfriado (39,7%), la faringitis (14,4%) y la bronquitis aguda (12,6%). Se prescribieron antibióticos en 4.675 ITR (27,9%), principalmente en neumonía (89,9%), amigdalitis (88,9%) y otitis media (87,3%). El criterio que más se asoció a prescripción antibiótica fue la presencia de exudado amigdalar (odds ratio [OR] de 32,1; intervalo de confianza [IC] del 95%: 24,5 a 42), seguido de otorrea (OR de 25,2; IC del 95%: 18,2 a 35) y esputo purulento (OR de 18,1; IC del 95%: 15,5 a 21,2); en cambio, fue protectora la tos (OR de 0,4; IC del 95%: 0,3 a 0,5).DiscusiónLa prescripción antibiótica en las ITR es muy elevada en España. Este estudio aporta información sobre factores predictores de tratamiento antibiótico fundamental para promover un uso más racional de antibióticos(AU)

ObjectiveHappy Audit project is a European-funded survey aimed at reducing antibiotic prescribing for respiratory tract infections (RTI). The aim of this study is to investigate the antibiotic treatment administered for these RTIs in Spain and to find out which criteria are associated with its use.DesignCross-sectional study carried out in January and February 2008.SettingPrimary health care.ParticipantsGeneral practitioners registered all the RTI during a 3-week period using a template.Principal measurementsAge and gender, days with symptoms, signs presented (fever, cough, purulent ear discharge, sore throat, tonsillar exudate, swollen neck glands, dyspnoea, increase in sputum, purulent sputum), diagnosis, antibiotic therapy and demand of antibiotics. A logistic regression with the prescription of antibiotic as the dependent variable was performed.ResultsOut of the 332 physicians invited to participate, 309 filled in and returned the templates (93.1%), registering 16,751 RTIs, with the common cold (39.7%), pharyngitis (14.4%) and acute bronchitis (12.6%) being the most common. Antibiotic therapy was given to 4,675 RTIs (27.9%), mainly for pneumonia (89.9%), tonsillitis (88.9%), and otitis media (87.3%). The criterion most associated with antibiotic therapy was the presence of tonsillar exudate (OR: 32.1; 95CI%: 24.5–42), followed by ear discharge (25.2; 95%CI: 18.2–35) and purulence of sputum (18.1; 95%CI: 15.5–21.2); conversely, cough (OR: 0.4; 95%CI: 0.3–0.5) was considered as protective factor.DiscussionAntibiotic treatment for RTIs is very high in our country. This study provides information on the criteria that predict this antibiotic therapy and is important to take into account if a more rational use of antibiotics is required(AU)