Management of Common Infections in German Primary Care: A Cross-Sectional Survey of Knowledge and Confidence among General Practitioners and Outpatient Pediatricians.

Peter Kurotschka,Johannes Forster,Johannes Liese,Ildiko Gagyor,Dominik Wolf,Nicola Thier,Elena Tiedemann

doi:10.3390/antibiotics10091131

Peter Kurotschka, Johannes Forster + Show 5 more

Open Access

https://doi.org/10.3390/antibiotics10091131

Copy DOI

Journal: Antibiotics	Publication Date: Sep 20, 2021
Citations: 2	License type: CC BY 4.0

Affiliation: University Hospital Würzburg

Abstract

Outpatient antibiotic use is closely related to antimicrobial resistance and in Germany, almost 70% of antibiotic prescriptions in human health are issued by primary care physicians (PCPs). The aim of this study was to explore PCPs, namely General Practitioners’ (GPs) and outpatient pediatricians’ (PDs) knowledge of guideline recommendations on rational antimicrobial treatment, the determinants of confidence in treatment decisions and the perceived need for training in this topic in a large sample of PCPs from southern Germany. Out of 3753 reachable PCPs, 1311 completed the survey (overall response rate = 34.9%). Knowledge of guideline recommendations and perceived confidence in making treatment decisions were high in both GPs and PDs. The two highest rated influencing factors on prescribing decisions were reported to be guideline recommendations and own clinical experiences, hence patients’ demands and expectations were judged as not influencing treatment decisions. The majority of physicians declared to have attended at least one specific training course on antibiotic use, yet almost all the participating PCPs declared to need more training on this topic. More studies are needed to explore how consultation-related and context-specific factors could influence antibiotic prescriptions in general and pediatric primary care in Germany beyond knowledge. Moreover, efforts should be undertaken to explore the training needs of PCPs in Germany, as this would serve the development of evidence-based educational interventions targeted to the improvement of antibiotic prescribing decisions rather than being focused solely on knowledge of guidelines.

Highlights

In the last decades, concerns around the growing health and economic burden of antimicrobial resistance (AMR) urged the international public health community and the national health systems to action [1,2]
To face AMR, reducing unnecessary antibiotic use is established as the leading strategy, with the aim to preserve the efficacy of these drugs [1,2], both in the hospital and in the outpatient sector [3]
The logistic regression analysis showed that working as a PD was significantly associated with more correct answers to the questions on tonsillitis management and otitis media compared to working as a General Practitioners’ (GPs)

Summary

Introduction

Concerns around the growing health and economic burden of antimicrobial resistance (AMR) urged the international public health community and the national health systems to action [1,2]. To face AMR, reducing unnecessary antibiotic use is established as the leading strategy, with the aim to preserve the efficacy of these drugs [1,2], both in the hospital and in the outpatient sector [3]. According to the European Surveillance of Antimicrobial Consumption Network (ESAC-net), community antibiotic use in Europe in 2019 ranged between 32.4 Defined Daily Doses (DDDs)/1000 inhabitants/day (DIDs) in Greece and 8.9 DIDs in the Netherlands [5]. To the European Surveillance of Antimicrobial Consumption Network (ESAC-net), community antibiotic use in Europe in 2019 ranged between 32.4 Defined Daily Doses (DDDs)/1000 inhabitants/day (DIDs) in Greece and 8.9 DIDs in the Netherlands [5]. Compared to other European countries, outpatient antibiotic use in Germany is relatively low but the proportion of prescribed second-line antibiotics is high [5].

Objectives

Methods

Findings

Discussion

Conclusion