title: Health Alliance for Prudent Prescribing, Yield and Use of Antimicrobial Drugs in the Treatment of Respiratory Tract Infections (HAPPY AUDIT).
abstract: BACKGROUND
  Excessive and inappropriate use of antibiotics is considered to be the most important reason for development of bacterial resistance to antibiotics. As antibiotic resistance may spread across borders, high prevalence countries may serve as a source of bacterial resistance for countries with a low prevalence. Therefore, bacterial resistance is an important issue with a potential serious impact on all countries. The majority of respiratory tract infections (RTIs) are treated in general practice. Most infections are caused by virus and antibiotics are therefore unlikely to have any clinical benefit. Several intervention initiatives have been taken to reduce the inappropriate use of antibiotics in primary health care, but the effectiveness of these interventions is only modest. Only few studies have been designed to determine the effectiveness of multifaceted strategies in countries with different practice setting. The aim of this study is to evaluate the impact of a multifaceted intervention targeting general practitioners (GPs) and patients in six countries with different prevalence of antibiotic resistance: Two Nordic countries (Denmark and Sweden), two Baltic Countries (Lithuania and Kaliningrad-Russia) and two Hispano-American countries (Spain and Argentina).
  
  
  METHODS
  HAPPY AUDIT was initiated in 2008 and the project is still ongoing. The project includes 15 partners from 9 countries. GPs participating in HAPPY AUDIT will be audited by the Audit Project Odense (APO) method. The APO method will be used at a multinational level involving GPs from six countries with different cultural background and different organisation of primary health care. Research on the effect of the intervention will be performed by analysing audit registrations carried out before and after the intervention. The intervention includes training courses on management of RTIs, dissemination of clinical guidelines with recommendations for diagnosis and treatment, posters for the waiting room, brochures to patients and implementation of point of care tests (Strep A and CRP) to be used in the GPs'surgeries. To ensure public awareness of the risk of resistant bacteria, media campaigns targeting both professionals and the public will be developed and the results will be published and widely disseminated at a Working Conference hosted by the World Association of Family Doctors (WONCA-Europe) at the end of the project period.
  
  
  CONCLUSIONS
  HAPPY AUDIT is an EU-financed project with the aim of contributing to the battle against antibiotic resistance through quality improvement of GPs' diagnosis and treatment of RTIs through development of intervention programmes targeting GPs, parents of young children and healthy adults. It is hypothesized that the use of multifaceted strategies combining active intervention by GPs will be effective in reducing prescribing of unnecessary antibiotics for RTIs and improving the use of appropriate antibiotics in suspected bacterial infections.
authors.affiliation: Research Unit of General Practice, University of Southern Denmark, Odense, Denmark. lbjerrum@sund.ku.dk
authors.forename: Lars
authors.initials: L
authors.lastname: Bjerrum
authors.forename: Anders
authors.initials: A
authors.lastname: Munck
authors.forename: Bente
authors.initials: B
authors.lastname: Gahrn-Hansen
authors.forename: Malene Plejdrup
authors.initials: MP
authors.lastname: Hansen
authors.forename: Dorte
authors.initials: D
authors.lastname: Jarboel
authors.forename: Carl
authors.initials: C
authors.lastname: Llor
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Cots
authors.forename: Silvia
authors.initials: S
authors.lastname: Hernández
authors.forename: Beatriz González
authors.initials: BG
authors.lastname: López-Valcárcel
authors.forename: Antoñia
authors.initials: A
authors.lastname: Pérez
authors.forename: Lidia
authors.initials: L
authors.lastname: Caballero
authors.forename: Walter
authors.initials: W
authors.lastname: von der Heyde
authors.forename: Ruta
authors.initials: R
authors.lastname: Radzeviviene
authors.forename: Arnoldas
authors.initials: A
authors.lastname: Jurgutis
authors.forename: Anatoliy
authors.initials: A
authors.lastname: Reutskiy
authors.forename: Elena
authors.initials: E
authors.lastname: Egorova
authors.forename: Eva Lena
authors.initials: EL
authors.lastname: Strandberg
authors.forename: Ingvar
authors.initials: I
authors.lastname: Ovhed
authors.forename: Sigvard
authors.initials: S
authors.lastname: Molstad
authors.forename: Robert
authors.initials: R
authors.lastname: vander Stichele
authors.forename: Ria
authors.initials: R
authors.lastname: Benko
authors.forename: Vera
authors.initials: V
authors.lastname: Vlahovic-Palcevski
authors.forename: Christos
authors.initials: C
authors.lastname: Lionis
authors.forename: Marit
authors.initials: M
authors.lastname: Rønning
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D054869:Clinical Audit / Q000379:methods*; D024881:Drug Resistance, Bacterial; D017723:Drug Utilization Review / Q000379:methods*; D005062:European Union; D005194:Family Practice; D006265:Health Care Coalitions; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000592:standards*; D015995:Prevalence; D012141:Respiratory Tract Infections / Q000188:drug therapy*
chemical_list: D000890:Anti-Infective Agents