Abstract
BackgroundIn most countries, including France, data on clinical indications for outpatient antibiotic prescriptions are not available, making it impossible to assess appropriateness of antibiotic use at prescription level.AimOur objectives were to: (i) propose proxy indicators (PIs) to estimate appropriateness of antibiotic use at general practitioner (GP) level based on routine reimbursement data; and (ii) assess PIs’ performance scores and their clinimetric properties using a large regional reimbursement database.MethodsA recent systematic literature review on quality indicators was the starting point for defining a set of PIs, taking French national guidelines into account. We performed a cross-sectional study analysing National Health Insurance data (available at prescriber and patient levels) on antibiotics prescribed by GPs in 2017 for individuals living in north-eastern France. We measured performance scores of the PIs and their case-mix stability, and tested their measurability, applicability, and room for improvement (clinimetric properties).ResultsThe 3,087 GPs included in this study prescribed a total of 2,077,249 antibiotic treatments. We defined 10 PIs with specific numerators, denominators and targets. Performance was low for almost all indicators ranging from 9% to 75%, with values < 30% for eight of 10 indicators. For all PIs, we found large variation between GPs and patient populations (case-mix stability). Regarding clinimetric properties, all PIs were measurable, applicable, and showed high improvement potential.ConclusionsThe set of 10 PIs showed satisfactory clinimetric properties and might be used to estimate appropriateness of antibiotic prescribing in primary care, in an automated way within antibiotic stewardship programmes.
Highlights
The vast majority of antibiotics for human use are prescribed in primary care, in particular by general practitioners (GPs), who prescribe ca 70% of total antibiotics used in France in the outpatient setting
Data on clinical indications for these outpatient antibiotic prescriptions are not available. To explore whether such routine data on the quantity of antibiotics can be used to estimate the appropriateness of antibiotic prescription by individual GPs, and taking the recent overview of outpatient quality indicators as a starting point [3], our objectives were to: (i) define proxy indicators (PIs) for appropriateness of antibiotic use based on these routine data; and (ii) assess the PIs’ performance scores and their clinimetric properties using a large regional reimbursement database
The 3,087 GPs included prescribed in 2017 a total of 2,077,249 antibiotic treatments that were dispensed to 1,335,401 individual patients
Summary
The vast majority of antibiotics for human use are prescribed in primary care, in particular by general practitioners (GPs), who prescribe ca 70% of total antibiotics used in France in the outpatient setting. In most countries, including France, data on clinical indications for outpatient antibiotic prescriptions are not available, making it impossible to assess appropriateness of antibiotic use at prescription level. Aim: Our objectives were to: (i) propose proxy indicators (PIs) to estimate appropriateness of antibiotic use at general practitioner (GP) level based on routine reimbursement data; and (ii) assess PIs’ performance scores and their clinimetric properties using a large regional reimbursement database. We performed a cross-sectional study analysing National Health Insurance data (available at prescriber and patient levels) on antibiotics prescribed by GPs in 2017 for individuals living in north-eastern France. Conclusions: The set of 10 PIs showed satisfactory clinimetric properties and might be used to estimate appropriateness of antibiotic prescribing in primary care, in an automated way within antibiotic stewardship programmes
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