Effectiveness of two types of intervention on antibiotic prescribing in respiratory tract infections in Primary Care in Spain. Happy Audit Study.
OBJECTIVE
To evaluate the effectiveness of two types of intervention in reducing antibiotic prescribing in respiratory tract infections (RTI).


METHODS
Before-after audit-based study.


METHODS
Primary Care centres in Spain.


METHODS
General practitioners (GPs) registered all patients with RTIs for 15 days in winter 2008 (pre-intervention), and again in winter 2009 (post-intervention).


METHODS
Intervention activities included meetings, with the presentation and discussion of the results, and several training meetings on RTI guidelines, information brochures for patients, workshops on point-of-care tests - rapid antigen detection tests and C-reactive protein rapid test - and provision of these tests in the clinic. All GPs, with the exception of those in Catalonia, made up the full intervention group (FIG); conversely, Catalan doctors underwent the same intervention, except for the workshop on rapid tests (partial intervention group, PIG). Multilevel logistic regression was performed taking the prescription of antibiotics as the dependent variable.


RESULTS
Out of a total of 309 GPs involved in the first register, 281 completed the intervention and the second register (90.9%), of which 210 were assigned to the FIG, and 71 to the PIG. The odds ratio of antibiotic prescribing after the intervention was 0.99 (95% CI: 0.89-1.10) among GPs assigned to PIG, and 0.50 (95% CI: 0.44-0.57, p<0.001) among those who were allocated to FIG. The reduction in antibiotic prescribing in FIG was more marked in flu infection, common cold, acute pharyngitis, acute tonsillitis, and acute bronchitis.


CONCLUSIONS
Active participation of GPs with the performance of point-of-care tests in the clinic is accompanied by a drastic reduction of antibiotic use in RTIs, primarily in infections considered as mainly viral.
University Rovira i Virgili, Primary Care Jaume I, Tarragona, Spain. Electronic address: carles.llor@urv.cat.
Carles
C
Llor
Leader of the Happy Audit Study in Spain and Coordinator of the GdT Enfermedades Infecciosas, Sociedad Española de Medicina de Familia y Comunitaria (semFYC), University of Barcelona. Primary Care La Marina, Barcelona, Spain.
Josep Maria
JM
Cots
University Rovira i Virgili, Primary Care Jaume I, Tarragona, Spain.
Silvia
S
Hernández
Primary Care Rincón de Soto, La Rioja, Spain.
Jesús
J
Ortega
Primary Care Arquitecte Bennàssar, Palma de Mallorca, Spain.
Javier
J
Arranz
Primary Care Rafalalena, Castellón, Spain.
María José
MJ
Monedero
Primary Care Bollulos Par del Condado, Huelva, Spain.
Juan de Dios
Jde D
Alcántara
Primary Care El Recinto, Ceuta, Spain.
Carolina
C
Pérez
Primary Care La Calzada II, Gijón, Spain.
Guillermo
G
García
Primary Care Mirasierra, Madrid, Spain.
Manuel
M
Gómez
Primary Care Escaleritas, Las Palmas de Gran Canaria, Spain.
Gloria
G
Guerra
Primary Care Teis, Vigo, Spain.
Marina
M
Cid
Primary Care Son Pisa, Mallorca, Spain.
María Luisa
ML
Cigüenza
Primary Care Serrería I, Valencia, Spain.
Vicenta
V
Pineda
Primary Care Hostalric, Girona, Spain.
José
J
Paredes
Primary Care District Gran Canaria, Spain.
Juan Luis
JL
Burgazzoli
Research Unit of General Practice, University of Southern Denmark, Odense, Denmark.
Anders
A
Munck
Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Denmark.
Gloria
G
Cordoba-Currea
Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Denmark.
Lars
L
Bjerrum
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D065187:Controlled Before-After Studies; D011307:Drug Prescriptions / Q000592:standards* / Q000706:statistics & numerical data*; D006801:Humans; D008485:Medical Audit; D011320:Primary Health Care; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D013030:Spain
D000900:Anti-Bacterial Agents
Antibiotics; Antibióticos; Audit; Infecciones del tracto respiratorio; Intervención; Intervention; Point-of-care test; Pruebas rápidas; Respiratory tract infections