Élise Fortin1, Geneviève Deceuninck2, Caroline Sirois2, Caroline Quach2, Marc Simard2, Marc Dionne2, Sonia Jean2, Alejandra Irace-Cima2, Nadine Magali-Ufitinema2. 1. Institut national de santé publique du Québec (Fortin, Deceuninck, Sirois, Simard, Jean, Irace-Cima), Québec, Que.; Department of Microbiology, Infectious Diseases and Immunology (Fortin, Quach), Faculty of Medicine, University of Montreal, Montréal, Que.; Department of Social and Preventive Medicine (Fortin, Sirois, Simard), Faculty of Medicine, Laval University; Centre d'excellence sur le vieillissement de Québec (Sirois), Centre de recherche du CHU de Québec; Faculty of Medicine (Dionne), Laval University; Centre de recherche du CHU de Québec (Dionne); Department of Medicine (Jean), Faculty of Medicine, Laval University; Direction de la prévention et du contrôle des maladies infectieuses (Magali-Ufitinema), Direction générale adjointe de la protection de la santé publique, Ministère de la Santé et des Services sociaux, Québec, Que. elise.fortin@inspq.qc.ca. 2. Institut national de santé publique du Québec (Fortin, Deceuninck, Sirois, Simard, Jean, Irace-Cima), Québec, Que.; Department of Microbiology, Infectious Diseases and Immunology (Fortin, Quach), Faculty of Medicine, University of Montreal, Montréal, Que.; Department of Social and Preventive Medicine (Fortin, Sirois, Simard), Faculty of Medicine, Laval University; Centre d'excellence sur le vieillissement de Québec (Sirois), Centre de recherche du CHU de Québec; Faculty of Medicine (Dionne), Laval University; Centre de recherche du CHU de Québec (Dionne); Department of Medicine (Jean), Faculty of Medicine, Laval University; Direction de la prévention et du contrôle des maladies infectieuses (Magali-Ufitinema), Direction générale adjointe de la protection de la santé publique, Ministère de la Santé et des Services sociaux, Québec, Que.
Abstract
BACKGROUND: In Quebec, antibiotic use is higher among outpatients with chronic diseases. We sought to measure compliance with provincial guidelines for the treatment of otitis media and common respiratory infections, and to measure variations in compliance according to the presence of certain chronic diseases. METHODS: We conducted a population-based study of linked data on antibiotic dispensing covered by the public drug insurance plan between April 2010 and March 2017. We included patients who had consulted a primary care physician within 2 days before being dispensed an antibiotic for an infection targeted by provincial guidelines, including bronchitis in patients with chronic obstructive pulmonary disease, otitis media, pharyngitis, pneumonia and sinusitis. We computed proportions of prescriptions compliant with guidelines (use of recommended antibiotic for children, and use of recommended antibiotic and dosage for adults) by age group (children or adults) and chronic disease (respiratory, cardiovascular, diabetes, mental disorder or none). We measured the impact of chronic diseases on compliance using robust Poisson regression. RESULTS: We analyzed between 14 677 and 198 902 prescriptions for each infection under study. Compliance was greater than 87% among children, but was lower among children with asthma (proportion ratios between 0.97 and 1.00). In adults, the chosen antibiotic was compliant for at least 73% of prescriptions, except for pharyngitis (≤ 61%). Accounting for dosage lowered compliance to between 31% and 61%. Compliance was lower in the presence of chronic diseases (proportion ratios between 0.94 and 0.98). INTERPRETATION: It is possible that prescribing noncompliant prescriptions was sometimes appropriate, but the high frequency of noncompliance suggests room for improvement. Given that variations associated with chronic diseases were small, disease-specific guidelines for antibiotic prescriptions are likely to have a limited impact on compliance.
BACKGROUND: In Quebec, antibiotic use is higher among outpatients with chronic diseases. We sought to measure compliance with provincial guidelines for the treatment of otitis media and common respiratory infections, and to measure variations in compliance according to the presence of certain chronic diseases. METHODS: We conducted a population-based study of linked data on antibiotic dispensing covered by the public drug insurance plan between April 2010 and March 2017. We included patients who had consulted a primary care physician within 2 days before being dispensed an antibiotic for an infection targeted by provincial guidelines, including bronchitis in patients with chronic obstructive pulmonary disease, otitis media, pharyngitis, pneumonia and sinusitis. We computed proportions of prescriptions compliant with guidelines (use of recommended antibiotic for children, and use of recommended antibiotic and dosage for adults) by age group (children or adults) and chronic disease (respiratory, cardiovascular, diabetes, mental disorder or none). We measured the impact of chronic diseases on compliance using robust Poisson regression. RESULTS: We analyzed between 14 677 and 198 902 prescriptions for each infection under study. Compliance was greater than 87% among children, but was lower among children with asthma (proportion ratios between 0.97 and 1.00). In adults, the chosen antibiotic was compliant for at least 73% of prescriptions, except for pharyngitis (≤ 61%). Accounting for dosage lowered compliance to between 31% and 61%. Compliance was lower in the presence of chronic diseases (proportion ratios between 0.94 and 0.98). INTERPRETATION: It is possible that prescribing noncompliant prescriptions was sometimes appropriate, but the high frequency of noncompliance suggests room for improvement. Given that variations associated with chronic diseases were small, disease-specific guidelines for antibiotic prescriptions are likely to have a limited impact on compliance.
Authors: Martin J Llewelyn; Jennifer M Fitzpatrick; Elizabeth Darwin; Cliff Gorton; John Paul; Tim E A Peto; Lucy Yardley; Susan Hopkins; Ann Sarah Walker Journal: BMJ Date: 2017-07-26
Authors: Timo Smieszek; Koen B Pouwels; F Christiaan K Dolk; David R M Smith; Susan Hopkins; Mike Sharland; Alastair D Hay; Michael V Moore; Julie V Robotham Journal: J Antimicrob Chemother Date: 2018-02-01 Impact factor: 5.790
Authors: Magdalena Nowakowska; Tjeerd van Staa; Anna Mölter; Darren M Ashcroft; Jung Yin Tsang; Andrew White; William Welfare; Victoria Palin Journal: J Antimicrob Chemother Date: 2019-11-01 Impact factor: 5.790
Authors: Katherine E Fleming-Dutra; Adam L Hersh; Daniel J Shapiro; Monina Bartoces; Eva A Enns; Thomas M File; Jonathan A Finkelstein; Jeffrey S Gerber; David Y Hyun; Jeffrey A Linder; Ruth Lynfield; David J Margolis; Larissa S May; Daniel Merenstein; Joshua P Metlay; Jason G Newland; Jay F Piccirillo; Rebecca M Roberts; Guillermo V Sanchez; Katie J Suda; Ann Thomas; Teri Moser Woo; Rachel M Zetts; Lauri A Hicks Journal: JAMA Date: 2016-05-03 Impact factor: 56.272
Authors: Yuanyuan Wang; Muh Akbar Bahar; Anouk M E Jansen; Janwillem W H Kocks; Jan-Willem C Alffenaar; Eelko Hak; Bob Wilffert; Sander D Borgsteede Journal: J Antimicrob Chemother Date: 2019-10-01 Impact factor: 5.790
Authors: Stanford T Shulman; Alan L Bisno; Herbert W Clegg; Michael A Gerber; Edward L Kaplan; Grace Lee; Judith M Martin; Chris Van Beneden Journal: Clin Infect Dis Date: 2012-09-09 Impact factor: 9.079