Antibiotic prescribing behavior among general practitioners – a questionnaire-based study in Germany

Salm, Florian; Schneider, Sandra; Schmücker, Katja; Petruschke, Inga; Kramer, Tobias Siegfried; Hanke, Regina; Schröder, C.; Heintze, Christoph; Schwantes, Ulrich; Gastmeier, Petra; Gensichen, Jochen

doi:10.1186/s12879-018-3120-y

Cited by 34 publications

(43 citation statements)

References 42 publications

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“…Interestingly, our data showed that in urbanized PCN practice locations, quinolone prescription rates were lower than in rural locations. This complements results from a previous study where German GPs working in urban areas were found to be more likely to use the strategy of delayed prescribing of antibiotics than GPs working in rural areas [8]. Such discrepancies between urban and rural prescribing habits potentially could root in more ample opportunities for self-re ection about prescribing motivated by regular peer exchange and a broader and more frequent offer of continued training and upskilling in urban locations.…”

Section: Discussionsupporting

confidence: 82%

“…However, strong variations of overall and age-group-speci c distributions of antibiotic subgroups could be identi ed [7]. A strong awareness of antimicrobial resistance has been observed among German General Practitioners (GPs), while measures to improve rational prescribing were found to be not widely implemented [8]. In more recent research, it was found that the use of antibiotics in German primary care showed large variations between and within medical specialties and season and that a considerable proportion of antibiotic prescriptions lacked conformity with national guideline recommendations [9].…”

Section: Introductionmentioning

confidence: 99%

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Baseline assessment of antibiotics prescribing for acute, non-complicated infections in primary care in Germany in the cluster randomized trial ARena

Poß-Doering

Weber

Kamradt

et al. 2020

Preprint

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BackgroundAntimicrobial resistance is fueled by inappropriate prescribing and use of antibiotics. Global and national strategies support rational and adequate use of antibiotics to retain treatment options and fight resistances. In Germany, the ARena project (Sustainable reduction of antibiotic-induced antimicrobial resistance) was intended to promote the rational and appropriate use of antibiotics for acute non-complicated infections by addressing physicians, care teams and patients through multiple interacting interventions. This paper presents patterns of antibiotics prescribing for patients with acute non-complicated infections in participating primary care networks prior to the start of the ARena project, explores variation across subgroups of patients and draws comparisons to reference groups which represent standard care. MethodsIn mixed logistic regression models, we explored factors associated with the proportion of patients with acute non-complicated infections consulting primary care practices who received an antibiotic prescription. Secondary outcomes concerned the prescription of different types of antibiotics. Descriptive methods were used to summarize the data referring to primary care networks, reference groups, and subgroups. ResultsAcross all observed cases, antibiotic prescription rates were 31.7% in reference groups and 32.0% in primary care networks. Being the largest group of physicians observed, General practitioners prescribed antibiotics more frequently than other medical specialist groups (otolaryngologists vs. General practitioners OR=0.465 CI=[0.302; 0.719], p<0.001, pediatricians vs. General practitioners: OR=0.369 CI=[0.135; 1.011], p=0.053). Quinolone prescription rates were moderate (8.1% in reference groups and 9.9% in primary care networks). Patients with comorbidities had a higher likelihood of receiving an antibiotic and quinolone prescription and were less likely to receive a recommended substance. Younger patients were less likely to receive antibiotics (OR=0.771 CI=[0.636; 0.933], p=0.008). Female gender was associated with higher rates of antibiotic prescriptions compared to males (OR=1.293 CI=[1.201, 1.392], p<0.001).Conclusion Prior to the ARena project, observed antibiotic prescription rates for acute non-complicated infections were moderate, but there was still room for improvement. The use of recommended substances was low which indicates a need for creating stronger awareness of guideline-conform use of antibiotics.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Baseline assessment of antibiotics prescribing for acute, non-complicated infections in primary care in Germany in the cluster randomized trial ARena

Poß-Doering

Weber

Kamradt

et al. 2020

Preprint

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“…Therefore, we systematically examined whether the prescription of the most commonly used phytopharmaceuticals to treat acute lower and upper tract respiratory infections is associated with lower antibiotic use as the disease progresses. Since the duration of the disease is a common reason for prescribing antibiotics [18,19], we also examined the effects of the use of phytopharmaceuticals on the duration of the disease.…”

Section: Introductionmentioning

confidence: 99%

Reduced antibiotic use after initial treatment of acute respiratory infections with phytopharmaceuticals- a retrospective cohort study

Martin

Konrad

Adarkwah

et al. 2020

Postgraduate Medicine

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Objectives: We examined the relationship between the initial treatment of acute lower and upper tract respiratory infections with phytopharmaceuticals and the duration of the disease as well as between the initial treatment and the use of antibiotics in the further course of the disease. Method: Outpatients from the IMS® Disease Analyzer database with diagnoses of acute respiratory infections between January 2015 and March 2019 were observed for 30 days. Patients who had been prescribed phytopharmaceuticals on the day of their diagnosis were matched with controls who had not received such prescriptions by treating practice, diagnosis, age, sex, insurance status, index year, and Charlson comorbidity score. Patients antibiotic precriptions on the day of diagnosis were excluded. Logistic regression was used to investigate the relationship between phytopharmaceutical prescription, antibiotic prescription in the further course of the disease, and duration of sick leave. Results: A total of 117,182 patients who had been prescribed phytopharmaceuticals and an equal number of controls were available for analysis. Phytotherapeutics were associated with fewer antibiotic prescriptions. Extract of Pelargonium sidoides root (odds ratio (OR) 0.49 [0.43-0.57]) and thyme extract (OR 0.62 [0.49-0.76]) exhibited the strongest effect among patients treated by general practitioners, while Pelargonium sidoides root extract (OR 0.57 [0.38-0.84]), thyme and ivy extract (OR 0.66 [0.60-0.73]), and thyme and primrose root extract (OR 0.67 [0.47-0.96]) proved most effective in pediatric patients. Patients receiving phytopharmaceuticals had a significantly lower risk of prolonged periods of sick leave. The risk of sick leave durations of >7 days was most markedly reduced in patients taking cineole (OR 0.74 [0.63-0.86]) and Pelargonium root extract (OR 0.79 [0.54-0.96]). Conclusion: The use of selected phytopharmaceuticals for acute respiratory infections is associated with a significantly reduced need for antibiotic prescriptions in the further course of the disease, as well as significantly shorter sick leaves.

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“…The CHANGE-3 study was one of a number of efforts to change habits of the use of antibiotics in German primary care conducted in recent years. Other studies focused on knowledge about factors causing antimicrobial resistance and strategies like delayed prescribing [25], online education on provider-patient-communication [26], attitudes and perceptions to antimicrobial resistances and preferred information sources [27] or used complex implementation programs to promote the rational use of antibiotics in primary care networks [28]. Impulses for primary care gained in these studies were collated in a recent symposium [29].…”

Section: Discussionmentioning

confidence: 99%

Converting Habits of Antibiotic Use for Respiratory Tract Infections in German Primary Care (Change-3) - Process Evaluation of a Complex Intervention

Poß-Doering¹,

Kühn

Kamradt

et al. 2020

Preprint

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Background: Antimicrobial resistance remains a global challenge. In Germany, the national health agenda supports measures that enhance the rational use of antibiotics. The study “Converting Habits of Antibiotic Use for Respiratory Tract Infections in German Primary Care (CHANGE-3)” aimed at a sustainable reduction of antimicrobial resistance through the conversion of habits of antibiotics use and an increase in health literacy in primary care patients, practice teams, and in the general public. Embedded in a cluster-randomized trial of a multifaceted implementation program, a process evaluation focused on the uptake of program components to assess the fidelity of the implementation program in the CHANGE-3 study and to understand utilization of its educational components. Methods: A mix of qualitative and quantitative methods was used. Semi-structured telephone interviews were conducted with General Practitioners, Medical Assistants, patients treated for respiratory tract infection and outreach visitors who had carried out individual outreach visits. A two-wave written survey (T1: 5 months after start, T2: 16 months after start) was conducted in general practitioners and medical assistants. Qualitative data were analyzed using thematic framework analysis. Descriptive statistics were used to analyze survey data. Results: Uptake of intervention components was heterogenous. Across all components, the uptake reported by General Practitioners varied from 20% to 88% at T1 and 31% to 63% at T2. Medical Assistants reported uptake from 22% to 70% at T1 and 6% to 69% at T2. Analog paper-based components could by and large be integrated in daily practice (64% to 90% in T1; 41% to 93% in T2), but uptake of digital components was low. A one-time outreach visit provided thematic information and feedback regarding actual prescribing, but due to time constraints were received with reluctance by practice teams. Patients were largely unaware of program components, but assumed that information and education could promote health literacy regarding antibiotics use. Conclusions: The uptake of program components was heterogeneous, with lowest uptake of the digital components. Potential effects of the implementation program (i.e. reduced antibiotics prescribing), will warrant careful analysis of contributing program components. Trial registration: ISRCTN, ISRCTN15061174. Registered 13 July 2018 – Retrospectively registered, http://www.isrctn.com/ISRCTN15061174

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Antibiotic prescribing behavior among general practitioners – a questionnaire-based study in Germany

Cited by 34 publications

References 42 publications

Baseline assessment of antibiotics prescribing for acute, non-complicated infections in primary care in Germany in the cluster randomized trial ARena

Baseline assessment of antibiotics prescribing for acute, non-complicated infections in primary care in Germany in the cluster randomized trial ARena

Reduced antibiotic use after initial treatment of acute respiratory infections with phytopharmaceuticals- a retrospective cohort study

Converting Habits of Antibiotic Use for Respiratory Tract Infections in German Primary Care (Change-3) - Process Evaluation of a Complex Intervention

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