title: Health Alliance for prudent antibiotic prescribing in patients with respiratory tract infections (HAPPY AUDIT) -impact of a non-randomised multifaceted intervention programme.
abstract: BACKGROUND
  Excessive use of antibiotics is worldwide the most important reason for development of antimicrobial resistance. 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. Initiatives have been taken to improve the quality of antibiotic prescribing in primary care, but only few studies have been designed to determine the effectiveness of multifaceted strategies across countries with different practice setting. The aim of this study was to evaluate the impact of a multifaceted intervention targeting general practitioners (GPs) and patients in six countries with different health organization and different prevalence of antibiotic resistance.
  
  
  METHODS
  GPs from two Nordic countries, two Baltic Countries and two Hispano-American countries registered patients with respiratory tract infections (RTIs) in 2008 and 2009. After first registration they received individual prescriber feedback and they were offered an intervention programme that included training courses, clinical guidelines, posters for waiting rooms, patient brochures and access to point of care tests (Strep A and C-Reactive Protein). Antibiotic prescribing rates were compared before and after the intervention.
  
  
  RESULTS
  A total of 440 GPs registered 47011 consultations; 24436 before the intervention (2008) and 22575 after the intervention (2009). After the intervention, the GPs significantly reduced the percentage of consultations resulting in an antibiotic prescription. In patients with lower RTI the GPs in Lithuania reduced the prescribing rate by 42%, in Russia by 25%, in Spain by 25%, and in Argentina by 9%. In patients with upper RTIs, the corresponding reductions in the antibiotic prescribing rates were in Lithania 20%, in Russia 15%, in Spain 9%, and in Argentina 5%.
  
  
  CONCLUSIONS
  A multifaceted intervention programme targeting GPs and patients and focusing on improving diagnostic procedures in patients with RTIs may lead to a marked reduction in antibiotic prescribing. The pragmatic before-after design used may suffer from some limitations and the reduction in antibiotic prescribing could be influenced by factors not related to the intervention.
authors.affiliation: Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, 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 Ejg
authors.initials: DE
authors.lastname: Jarbol
authors.forename: Gloria
authors.initials: G
authors.lastname: Cordoba
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: Antonia
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: Radzeviciene
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: Mölstad
authors.forename: Robert Vander
authors.initials: RV
authors.lastname: 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: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D011307:Drug Prescriptions / Q000592:standards*; D004363:Drug Utilization / Q000592:standards; D005260:Female; D058006:General Practice; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents