Abstract
BackgroundBetween-country differences have been described in antibiotic prescribing for respiratory tract infection (RTI) in primary care, but not yet for diagnostic testing procedures and prescribing confidence.AimTo describe between-country differences in RTI management, particularly diagnostic testing and antibiotic prescribing, and investigate which factors relate to antibiotic prescribing and GPs’ prescribing confidence.Design & settingProspective audit in 18 European countries.MethodAn audit of GP-registered patient, clinical, and management characteristics for patients presenting with sore throat and/or lower RTI (n = 4982), and GPs' confidence in their antibiotic prescribing decision. Factors related to antibiotic prescribing and confidence were analysed using multi-level logistic regression.ResultsAntibiotic prescribing proportions varied considerably: <20% in four countries, and >40% in six countries. There was also considerable variation in point-of-care (POC) testing (0% in Croatia, Moldova, and Romania, and >65% in Denmark and Norway, mainly for C-reactive protein [CRP] and group A streptococcal [strep A] infection), and in laboratory or hospital-based testing (<3% in Hungary, the Netherlands, and Spain, and >30% in Croatia, Georgia, Greece, and Moldova, mainly chest X-ray and white blood cell counting). Antibiotic prescribing was related to illness severity, comorbidity, age, fever, and country, but not to having performed a POC test. In nearly 90% of consultations, GPs were confident in their antibiotic prescribing decision.ConclusionDespite high confidence in decisions about antibiotic prescribing, there is considerable variation in the primary care of RTI in European countries, with GPs prescribing antibiotics overall more often than is considered appropriate. POC testing may enhance the quality of antibiotic prescribing decisions if it can safely reverse decisions confidently made on clinical grounds alone to prescribe antibiotics.
Highlights
Sequential studies by the European Centre for Disease Prevention and Control have identified important between-country differences in the numbers and class of antibiotics used,[1,2] and there is evidence that this variation is not warranted on clinical grounds.[3]
POC testing may enhance the quality of antibiotic prescribing decisions if it can safely reverse decisions confidently made on clinical grounds alone to prescribe antibiotics
Large between-country variation in antibiotic prescribing for respiratory tract infection exists in European primary care
Summary
Sequential studies by the European Centre for Disease Prevention and Control have identified important between-country differences in the numbers and class of antibiotics used,[1,2] and there is evidence that this variation is not warranted on clinical grounds.[3]. About 80-90% of antibiotics are prescribed in primary care, where over-prescribing is common for respiratory tract infections (RTI).[12,13] RTI is often of viral aetiology and self-limiting, making this condition the main target for improving the quality of antibiotic prescribing decisions.[14,15] Challenges facing prescribers include uncertainty about aetiology, unavailability of point-of-care (POC) diagnostic testing to aid prescribing decisions, unfamiliarity with current guidelines, risk-adverse prescribing behaviour and non-evidence based patients’ expectations about effectiveness of antibiotics.[16,17,18,19,20] Additional influences include health care system and cultural factors.[3,21,22]. Between-country differences have been described in antibiotic prescribing for RTI in primary care, but not yet for diagnostic testing procedures and prescribing confidence
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