title: Quality assessment of diagnosis and antibiotic treatment of infectious diseases in primary care: a systematic review of quality indicators.
abstract: OBJECTIVE
  To identify existing quality indicators (QIs) for diagnosis and antibiotic treatment of patients with infectious diseases in primary care.
  
  
  METHODS
  A systematic literature search was performed in PubMed and EMBASE. We included studies with a description of the development of QIs for diagnosis and antibiotic use in patients with infectious diseases in primary care. We extracted information about (1) type of infection; (2) target for quality assessment; (3) methodology used for developing the QIs; and (4) whether the QIs were developed for a national or international application. The QIs were organised into three categories: (1) QIs focusing on the diagnostic process; (2) QIs focusing on the decision to prescribe antibiotics; and (3) QIs concerning the choice of antibiotics.
  
  
  RESULTS
  Eleven studies were included in this review and a total of 130 QIs were identified. The majority (72%) of the QIs were focusing on choice of antibiotics, 22% concerned the decision to prescribe antibiotics, and few (6%) concerned the diagnostic process. Most QIs were either related to respiratory tract infections or not related to any type of infection. A consensus method (mainly the Delphi technique), based on either a literature study or national guidelines, was used for the development of QIs in all of the studies.
  
  
  CONCLUSIONS
  The small number of existing QIs predominantly focuses on the choice of antibiotics and is often drug-specific. There is a remarkable lack of diagnostic QIs. Future development of new QIs, especially disease-specific QIs concerning the diagnostic process, is needed. KEY POINTS In order to improve the use of antibiotics in primary care, measurable instruments, such as quality indicators, are needed to assess the quality of care being provided. A total of 11 studies were found, including 130 quality indicators for diagnosis and antibiotic treatment of infectious diseases in primary care. The majority of the identified quality indicators were focusing on the choice of antibiotics and only a few concerned the diagnostic process. All quality indicators were developed by means of a consensus method and were often based on literature studies or guidelines.
authors.affiliation: a Department of Clinical Microbiology , Herlev University Hospital , Herlev , Denmark ;|b Department of Public Health, Research Unit for General Practice and Section of General Practice , University of Copenhagen , Copenhagen , Denmark ;
authors.forename: Laura Trolle
authors.initials: LT
authors.lastname: Saust
authors.affiliation: a Department of Clinical Microbiology , Herlev University Hospital , Herlev , Denmark ;|b Department of Public Health, Research Unit for General Practice and Section of General Practice , University of Copenhagen , Copenhagen , Denmark ;
authors.forename: Rikke Nygaard
authors.initials: RN
authors.lastname: Monrad
authors.affiliation: c Centre for Research in Evidence-Based Practice , Bond University , Robina , Australia ;|d Department of Public Health, Research Unit of General Practice , University of Southern Denmark , Odense , Denmark.
authors.forename: Malene Plejdrup
authors.initials: MP
authors.lastname: Hansen
authors.affiliation: a Department of Clinical Microbiology , Herlev University Hospital , Herlev , Denmark ;
authors.forename: Magnus
authors.initials: M
authors.lastname: Arpi
authors.affiliation: b Department of Public Health, Research Unit for General Practice and Section of General Practice , University of Copenhagen , Copenhagen , Denmark ;
authors.forename: Lars
authors.initials: L
authors.lastname: Bjerrum
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003141:Communicable Diseases / Q000188:drug therapy*; D032921:Consensus; D003657:Decision Making; D003697:Delphi Technique; D004363:Drug Utilization / Q000706:statistics & numerical data*; D006801:Humans; D007400:Interprofessional Relations; D011320:Primary Health Care; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D012141:Respiratory Tract Infections / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic; general practice; infectious diseases; primary care; quality assessment; review quality indicator