title: Antibiotic prescribing in relation to diagnoses and consultation rates in Belgium, the Netherlands and Sweden: use of European quality indicators.
abstract: OBJECTIVE
  To assess the quality of antibiotic prescribing in primary care in Belgium, the Netherlands and Sweden using European disease-specific antibiotic prescribing quality indicators (APQI) and taking into account the threshold to consult and national guidelines.
  
  
  METHODS
  A retrospective observational database study.
  
  
  METHODS
  Routine primary health care registration networks in Belgium, the Netherlands and Sweden.
  
  
  METHODS
  All consultations for one of seven acute infections [upper respiratory tract infection (URTI), sinusitis, tonsillitis, otitis media, bronchitis, pneumonia and cystitis] and the antibiotic prescriptions in 2012 corresponding to these diagnoses.
  
  
  METHODS
  Consultation incidences for these diagnoses and APQI values (a) the percentages of patients receiving an antibiotic per diagnosis, (b) the percentages prescribed first-choice antibiotics and (c) the percentages prescribed quinolones.
  
  
  RESULTS
  The consultation incidence for respiratory tract infection was much higher in Belgium than in the Netherlands and Sweden. Most of the prescribing percentage indicators (a) were outside the recommended ranges, with Belgium deviating the most for URTI and bronchitis, Sweden for tonsillitis and the Netherlands for cystitis. The Netherlands and Sweden prescribed the recommended antibiotics (b) to a higher degree and the prescribing of quinolones exceeded the proposed range for most diagnoses (c) in Belgium. The interpretation of APQI was found to be dependent on the consultation incidences. High consultation incidences were associated with high antibiotic prescription rates. Taking into account the recommended treatments from national guidelines improved the results of the APQI values for sinusitis in the Netherlands and cystitis in Sweden.
  
  
  CONCLUSIONS
  Quality assessment using European disease-specific APQI was feasible and their inter-country comparison can identify opportunities for quality improvement. Their interpretation, however, should take consultation incidences and national guidelines into account. Differences in registration quality might limit the comparison of diagnosis-linked data between countries, especially for conditions such as cystitis where patients do not always see a clinician before treatment. Key points The large variation in antibiotic use between European countries points towards quality differences in prescribing in primary care.  • The European disease-specific antibiotic prescribing quality indicators (APQI) provide insight into antibiotic prescribing, but need further development, taking into account consultation incidences and country-specific guidelines.  • The incidence of consultations for respiratory tract infections was almost twice as high in Belgium compared to the Netherlands and Sweden.  • Comparison between countries of diagnosis-linked data were complicated by differences in data collection, especially for urinary tract infections.
authors.affiliation: a Department of Clinical Sciences , General Practice, Lund University , Lund , Sweden.
authors.forename: Mia
authors.initials: M
authors.lastname: Tyrstrup
authors.affiliation: b Julius Center for Health Sciences and Primary Care , University Medical Center Utrecht , Utrecht , the Netherlands.
authors.forename: Alike
authors.initials: A
authors.lastname: van der Velden
authors.affiliation: c Primary Care Research and Development Unit , Jönköping , Sweden.
authors.forename: Sven
authors.initials: S
authors.lastname: Engstrom
authors.affiliation: d Katholieke Universiteit Leuven , Academic Center for General Practice , Leuven , Belgium.
authors.forename: Geert
authors.initials: G
authors.lastname: Goderis
authors.affiliation: a Department of Clinical Sciences , General Practice, Lund University , Lund , Sweden.
authors.forename: Sigvard
authors.initials: S
authors.lastname: Molstad
authors.affiliation: b Julius Center for Health Sciences and Primary Care , University Medical Center Utrecht , Utrecht , the Netherlands.
authors.forename: Theo
authors.initials: T
authors.lastname: Verheij
authors.affiliation: e Department of Primary and Interdisciplinary Care (ELIZA) , Center for General Practice, University of Antwerp , Antwerp , Belgium.|f Laboratory of Medical Microbiology , Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp , Antwerp , Belgium.|g Department of Epidemiology and Social Medicine , University of Antwerp , Antwerp , Belgium.
authors.forename: Samuel
authors.initials: S
authors.lastname: Coenen
authors.affiliation: e Department of Primary and Interdisciplinary Care (ELIZA) , Center for General Practice, University of Antwerp , Antwerp , Belgium.|f Laboratory of Medical Microbiology , Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp , Antwerp , Belgium.
authors.forename: Niels
authors.initials: N
authors.lastname: Adriaenssens
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001530:Belgium; D002648:Child; D002675:Child, Preschool; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010033:Otitis Media; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D019984:Quality Indicators, Health Care; D012017:Referral and Consultation; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000188:drug therapy*; D012189:Retrospective Studies; D013548:Sweden; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: General practice; anti-bacterial agents; drug therapy; evidence-based medicine; quality of health care