title: Antibiotic prescribing during office hours and out-of-hours: a comparison of quality and quantity in primary care in the Netherlands.
abstract: BACKGROUND
  Unnecessary and non-first-choice antibiotic prescribing is a significant problem in primary care. It is often argued that irrational prescribing is higher during out-of-hours (OOH) consultations.
  
  
  OBJECTIVE
  To obtain insight into the quantity and quality of OOH antibiotic prescribing for commonly presented infectious diseases.
  
  
  METHODS
  Two two-way comparisons of 1) nationally dispensed antibiotics during office hours and OOH care, using data from the Dutch Foundation of Pharmaceutical Statistics, and 2) regional prescribing quality data from 45 primary care practices from Utrecht and its vicinity, and two large OOH services in Utrecht and Woerden.
  
  
  METHODS
  From the national data, yearly dispensed antibiotics were analysed per prescriber type, with respect to time (office hours or OOH) of prescription, types of antibiotics, and patients' age group. Regional prescribing rates, choice of antibiotic, and appropriateness of prescribing were compared for otitis media, sinusitis, tonsillitis, bronchitis, cystitis, and impetigo. Appropriateness was assessed by comparing all relevant information from medical files with the guideline recommendations.
  
  
  RESULTS
  Only 6% of GP-prescribed antibiotics were prescribed OOH. OOH, cystitis and acute otitis media presented most often. First-choice prescribing was comparable for the two settings, whereas prescribing rates were higher OOH, with comparatively more amoxicillin(/clavulanate). The appropriateness evaluation, however, revealed that overprescribing was comparable, or even lower than, for daily practice.
  
  
  CONCLUSIONS
  The suggestion that OOH antibiotic prescribing quality is worse than in daily practice does not seem founded. The higher OOH prescribing rates can be explained by a different population of presenting patients. The appropriateness of prescribing rather than prescribing rates, therefore, should be used to determine quality.
authors.affiliation: University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Vera Ec
authors.initials: VE
authors.lastname: Debets
authors.affiliation: University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Theo Jm
authors.initials: TJ
authors.lastname: Verheij
authors.affiliation: University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Alike W
authors.initials: AW
authors.lastname: van der Velden
mesh_terms: D039602:After-Hours Care / Q000706:statistics & numerical data*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001991:Bronchitis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D011307:Drug Prescriptions; D019983:Guideline Adherence; D006801:Humans; D007169:Impetigo / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D057970:Inappropriate Prescribing / Q000517:prevention & control / Q000706:statistics & numerical data*; D009426:Netherlands / Q000453:epidemiology; D010033:Otitis Media / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D019984:Quality Indicators, Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012852:Sinusitis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D014069:Tonsillitis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotics; drug prescribing; infectious disease; out-of-hours service; prescribing quality; primary care