Appropriate prescription of antibiotics due to multi-modal approaches

Abstract

Introduction : In the modern pharmacotherapy antibiotics are very important. For many diseases they help effectively and even save lives. However, antibiotic resistance occurs when bacteria change in response to the use of these medicines – this is a worldwide problem and is referable to the inappropriate use and prescription of antibiotics. Policy context and objective : Gesundes Kinzigtal (GK), which is a regional Integrated Care System in the state of Baden-Wurttemberg (BW) in Germany, is initiating different activities based on a multi-modal approach in order to better inform physicians and patients about antibiotics. The goal is to sensitize physicians and patients for an appropriate intake of antibiotics in order to decrease the prescription rate, to not unnecessary burden the health condition of the patients. Targeted population : The target population are the insured persons of the AOK-BW and the former LKK who are living in the region of Kinzigtal in all age classes (~ 33,000 insured persons). Highlights : GK organizes activities in order to reduce prescription of antibiotics. Since 2011 GK regularly organizes the pharmaceutical council, an interdisciplinary training about different topics as for example the use of antibiotics. In course of this interactive advanced training the participants have the chance to refresh their existing and develop new knowledge which can be applied in their practical work. The pharmaceutical commission holds their meetings since 2009 and deals with current pharmaceutical topics, which have a high relevance for the practice. Furthermore, it is conducive to the development and continuation of a rational pharmaceutical therapy on the basis of evidence-based medicine. Synchronizing the pharmaceutical therapy between the physicians, hospitals and pharmacies is priority. The exchange makes a narrow cross-sectoral cooperation possible. Additionally, the trainings for the physicians and pharmacists and the clarification for the patients are important. In an education campaign called “Purposeful or not at all” patients should be sensitized for antibiotics. GK strengthens the attention via information material such as poster, practice TV or newspaper reports and via health lectures. In Germany other projects exist already which aim for clarification for patients. However, GK has a more direct access to the patients due to interdisciplinary and cross-sectoral cooperation with the network partners. Moreover, different activities are offered which are complementary and strengthen each other. An evaluation about prescription of the defined daily doses (DDD) comparing Germany and BW and GK shows that in all age classes in GK the physicians prescribe less DDD compared to Germany and BW from 2008 to 2014 looking at the prescription rates. GK starts with lower rates of DDD per person and in some age classes decreases even more. In the comparison between cooperating physicians of GK and not cooperating physicians in this region, the cooperating physicians show greater reductions in prescribing antibiotics. Transferability : The multi-modal approach and cross-sectoral cooperation between the different stakeholders could be applied in other areas as well in order to reduce the use of antibiotics. Conclusions : Although there is a decreasing trend of prescribing antibiotics in Germany and GK there should be even more interventions since still potentials for optimization can be observed.