Introduction: Antibiotic resistance is a serious threat to global public health. It reduces the effectiveness of treatments for serious bacterial infections and thus increases the risk of fatal outcomes. Antibiotic prescriptions are often not in line with clinical evidence-based guidelines. The process of emergence of resistant bacteria can be slowed down by adherence to guidelines. Yet this adherence seems to be lacking in primary health care.Methods and Analysis: This pragmatic quasi-experimental study using a controlled before-after design was carried out in South-East-Lower Saxony in 2018–2020. The voluntary attendance of interactive trainings with condensed presentation of current guidelines for general practitioners (GP) on antibiotic management for urinary and respiratory tract infections is regarded as intervention. Those GP not attending the trainings constitute the control group. Data were collected via questionnaires; routine health records are provided by a statutory health insurance. The primary outcome is the proportion of (guideline-based) prescriptions in relation to the relevant ICD-10 codes as well as daily defined doses and the difference in proportion of certain prescriptions according to guidelines before and after the intervention as compared to the control group. Further outcomes are among others the subjectively perceived risk of antibiotic resistance and the attitude toward the guidelines. The questionnaires to assess this are based on theory of planned behavior (TPB) and health action process approach (HAPA). Variations over time and effects caused by measures other than WASA (Wirksamkeit von Antibiotika-Schulungen in der niedergelassenen Aerzteschaft-Effectiveness of antibiotic management training in the primary health care sector) training are taken into account by including the control group and applying interrupted time series analysis.Ethics and Dissemination: The study protocol and the data protection concept respectively were reviewed and approved by the Ethics Committee of the Hannover Medical School and the Federal Commissioner for Data Protection and Freedom of Information.Trial Registration:https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013951, identifier DRKS00013951.
As part of the EU-funded project, European Urban Health Indicator System (EURO-URHIS), a definition of urban areas (UAs) and of urban populations was needed to be able to identify comparable UAs in all member states. A literature review on existing definitions, as well as those used by other relevant projects, was performed. A survey of national experts in public health or land planning was also conducted. An algorithm was proposed to find UAs, which were feasible for the focus of EURO-URHIS. No unique general definition of UAs was found. Different fields of research define UAs differently. None of the definitions found were feasible for EURO-URHIS. All of them were found to have critical disadvantages when applied to an urban health project. An ideal definition for this type of project needs to provide a description of the situation without recourse to administrative boundaries yet inform the collection of routine data for urban health monitoring. These requirements were found to contradict each other and were not met in any existing definition. An algorithm was developed for the definition of UAs for the purpose of this study whereby national experts would select regions which are urban as an agglomeration or as a metropolitan area and which are potentially interesting in terms of public health; identify the natural boundaries, where countryside ends and residential or commercial areas of the region begin (e.g. by aerial photos); identify local government boundaries or other official boundaries used for routine data collection purposes which approximate the natural UA as closely as possible and list all administrative areas which are contained in the larger UA. The aggregation of all administrative areas within the original region formed the UA which was used in the project.
Antimicrobial resistance is one of the most important health topics of the past few years. To identify regional trends of antimicrobial resistance in inpatient and outpatient care, the Governmental Institute of Public Health of Lower Saxony (Germany) launched the sentinel system ARMIN (Antimicrobial Resistance Monitoring in Lower Saxony). Currently 9 laboratories participate as sentinel sites and contribute single case data of their microbiological results. Data are presented by an interactive data query in the internet. From 2006 to 2010 laboratories reported about 800 000 diagnostic test results. The proportion of MRSA (methicillin-resistant Staphylococcus aureus) among all Staphylococcus aureus increased from 19.5% in 2006 to 23.4% in 2010 for inpatient care in Lower Saxony. During the same period Escherichia coli resistance to cefotaxime for inpatient care increased from 3.0% to 8.8%. Enterococcus faecium resistance to vancomycin decreased from 13.6% to 5.6%. Currently the emphasis of ARMIN is on the description of trends and on the information of prescribing physicians. A quality circle was established to improve standardisation.
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