Carles Llor1, Josep Maria Cots2, Silvia Hernández3, Jesús Ortega4, Javier Arranz5, María José Monedero6, Juan de Dios Alcántara7, Carolina Pérez8, Guillermo García9, Manuel Gómez10, Gloria Guerra11, Marina Cid12, María Luisa Cigüenza13, Vicenta Pineda14, José Paredes15, Juan Luis Burgazzoli16, Anders Munck17, Gloria Cordoba-Currea18, Lars Bjerrum18. 1. University Rovira i Virgili, Primary Care Jaume I, Tarragona, Spain. Electronic address: carles.llor@urv.cat. 2. 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. 3. University Rovira i Virgili, Primary Care Jaume I, Tarragona, Spain. 4. Primary Care Rincón de Soto, La Rioja, Spain. 5. Primary Care Arquitecte Bennàssar, Palma de Mallorca, Spain. 6. Primary Care Rafalalena, Castellón, Spain. 7. Primary Care Bollulos Par del Condado, Huelva, Spain. 8. Primary Care El Recinto, Ceuta, Spain. 9. Primary Care La Calzada II, Gijón, Spain. 10. Primary Care Mirasierra, Madrid, Spain. 11. Primary Care Escaleritas, Las Palmas de Gran Canaria, Spain. 12. Primary Care Teis, Vigo, Spain. 13. Primary Care Son Pisa, Mallorca, Spain. 14. Primary Care Serrería I, Valencia, Spain. 15. Primary Care Hostalric, Girona, Spain. 16. Primary Care District Gran Canaria, Spain. 17. Research Unit of General Practice, University of Southern Denmark, Odense, Denmark. 18. Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Denmark.
Abstract
OBJECTIVE: To evaluate the effectiveness of two types of intervention in reducing antibiotic prescribing in respiratory tract infections (RTI). DESIGN: Before-after audit-based study. SETTING: Primary Care centres in Spain. PARTICIPANTS: General practitioners (GPs) registered all patients with RTIs for 15 days in winter 2008 (pre-intervention), and again in winter 2009 (post-intervention). INTERVENTIONS: 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.
OBJECTIVE: To evaluate the effectiveness of two types of intervention in reducing antibiotic prescribing in respiratory tract infections (RTI). DESIGN: Before-after audit-based study. SETTING: Primary Care centres in Spain. PARTICIPANTS: General practitioners (GPs) registered all patients with RTIs for 15 days in winter 2008 (pre-intervention), and again in winter 2009 (post-intervention). INTERVENTIONS: 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.
Authors: Carl Llor; Ana Moragas; Carolina Bayona; Josep M Cots; José M Molero; Joana Ribas; Julio Francisco Fóthy; Isabel Gutiérrez; Coro Sánchez; Jesús Ortega; Javier Arranz; Jenifer Botanes; Purificación Robles Journal: BMJ Open Date: 2017-06-06 Impact factor: 2.692
Authors: Carles Llor; Miriam Alkorta Gurrutxaga; Josep de la Flor I Bru; Sílvia Bernárdez Carracedo; José Luis Cañada Merino; Mario Bárcena Caamaño; Carmen Serrano Martino; Josep Maria Cots Yago Journal: Aten Primaria Date: 2017-06-13 Impact factor: 1.137
Authors: Rafa Ruiz; Ana Moragas; Marta Trapero-Bertran; Antoni Sisó; Anna Berenguera; Glòria Oliva; Alícia Borràs-Santos; Ana García-Sangenís; Jaume Puig-Junoy; Josep M Cots; Rosa Morros; Toni Mora; Anna Lanau-Roig; Ramon Monfà; Amelia Troncoso; Rosa M Abellana; Pau Gálvez; Laura Medina-Perucha; Lars Bjerrum; Isabel Amo; Nieves Barragán; Carl Llor Journal: Trials Date: 2019-12-17 Impact factor: 2.279
Authors: Nahara Anani Martínez-González; Ellen Keizer; Andreas Plate; Samuel Coenen; Fabio Valeri; Jan Yvan Jos Verbakel; Thomas Rosemann; Stefan Neuner-Jehle; Oliver Senn Journal: Antibiotics (Basel) Date: 2020-09-16