Abstract
Outpatient antibiotic use in Belgium is among the highest in Europe. The most common reason for an encounter in out-of-hours (OOH) primary care is an infection. In this study, we assessed all consultations from July 2016 to June 2018 at five OOH services. We described antibiotic prescribing by diagnosis, calculated disease-specific antibiotic prescribing quality indicators’ (APQI) values and critically appraised these APQI. We determined that 111,600 encounters resulted in 26,436 (23.7%) antibiotic prescriptions. The APQI diagnoses (i.e., bronchitis, upper respiratory infection, cystitis, tonsillitis, sinusitis, otitis media, and pneumonia) covered 14,927 (56.7%) antibiotic prescriptions. Erysipelas (1344 (5.1%)) and teeth/gum disease (982 (3.7%)) covered more prescriptions than sinusitis or pneumonia. Over 75% of patients with tonsillitis and over 50% with bronchitis, sinusitis, and otitis media were prescribed an antibiotic. Only for otitis media the choice of antibiotic was near the acceptable range. Over 10% of patients with bronchitis or pneumonia and over 25% of female patients with an acute cystitis received quinolones. The APQI cover the diagnoses for only 57% of all antibiotic prescriptions. As 5.1% and 3.7% of antibiotic prescriptions are made for erysipelas and teeth/gum disease, respectively, we propose to add these indications when assessing antibiotic prescribing quality in OOH primary care.
Highlights
Antibiotic use in Belgium is among the highest in Europe, especially in ambulatory care, and the risk for antimicrobial resistance is high [1]
From 1/7/2016 until 30/6/2018, 26,436 antibiotic prescriptions were registered in 111,600 visits covering a population of 811,097 persons
Most respiratory tract infections are self-limiting and usually caused by viral pathogens, at least half of the patients diagnosed with acute otitis media, sinusitis, tonsillitis, and bronchitis receive a prescription for an antibiotic at the general practitioner cooperatives (GPCs)
Summary
Antibiotic use in Belgium is among the highest in Europe, especially in ambulatory care, and the risk for antimicrobial resistance is high [1]. Consumption (ESAC) [2] project has developed a set of 21 disease-specific antibiotic prescribing quality indicators (APQI) to assess the quality of antibiotic prescribing in primary care [3]. These APQI have been adopted in several evaluations of antibiotic prescribing in Europe [4,5,6]. In Belgium, and in the rest of Europe, the on-going establishment of large-scale general practitioner cooperatives (GPCs) represents one of the most important developments for primary OOH health care. Previous research in Belgium showed similar APQI values for in- and out-of-hours care, using the data of a singular general practitioner cooperative (GPC)
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