Abstract
Insight into antibiotic prescribing quality is key to general practitioners (GPs) to improve their prescribing behavior and to national antibiotic surveillance and stewardship programs. Additionally to numbers of prescribed antibiotics, quality indicators (QIs) linked to the clinical indication for prescribing are urgently needed. The aim of this proof of concept study was to define indication-linked QIs which can be easily implemented in Dutch primary care by collaborating with data-extraction/processing companies that routinely process patient data for GP practices. An expert group of academic and practicing GPs defined indication-linked QIs for which outcomes can be derived from routine care data. QI outcomes were calculated and fed back to GPs from 44 practices, associations between QI outcomes were determined, and GPs’ opinions and suggestions with respect to the new set were captured using an online questionnaire. The new set comprises: (1) total number of prescribed antibiotics per 1000 registered patients and percentages of generally non-1st choice antibiotics; (2) prescribing percentages for episodes of upper and lower respiratory tract infection; (3) 1st choice prescribing for episodes of tonsillitis, pneumonia and cystitis in women. Large inter-practice variation in QI outcomes was found. The validity of the QI outcomes was confirmed by associations that were expected. The new set was highly appreciated by GPs and additional QIs were suggested. We conclude that it proved feasible to provide GPs with informative, indication-linked feedback of their antibiotic prescribing quality by collaborating with established data extraction/processing companies. Based on GPs’ suggestions the set will be refined and extended and used in the near future as yearly feedback with benchmarking for GPs and for national surveillance and stewardship purposes.
Highlights
General practitioners (GPs) are responsible for prescribing 80% of antibiotics in the outpatient setting and have a major responsibility to continuously focus on appropriate antibiotic prescribing [1]
In this study we have shown the feasibility of using routine primary health care data to determine antibiotic prescribing quality indicators (QIs) outcomes, with additional novelties of linking to clinical indications and analyzing disease episodes
The pilot set of 10 QIs was highly appreciated by GPs and seen as a stimulus to appropriate prescribing habits
Summary
General practitioners (GPs) are responsible for prescribing 80% of antibiotics in the outpatient setting and have a major responsibility to continuously focus on appropriate antibiotic prescribing [1]. Inappropriate antibiotic prescribing, defined as non-indicated and/or non-1st choice prescribing, is the main driver of antimicrobial resistance (AMR) [2,3]. AMR has become a major and challenging global health issue [4,5], as it results in reduced efficiency of antibiotics, making treatment of infectious diseases complicated, costly and ineffective [6]. The Center for Disease Control and Prevention defined outpatient antibiotic stewardship as the efforts: (1) to measure antibiotic prescribing; (2) to improve antibiotic prescribing by clinicians and use by patients so that antibiotics are only prescribed and used when needed; (3) to minimize mis- or delayed diagnoses leading to underuse of antibiotics; (4) to ensure that the right drug, dose, and duration are selected when an antibiotic is needed [6]
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