Quality assessment in general practice: diagnosis and antibiotic treatment of acute respiratory tract infections

TY - JOUR

T1 - Quality assessment in general practice

T2 - diagnosis and antibiotic treatment of acute respiratory tract infections

AU - Saust, Laura Trolle

AU - Bjerrum, Lars

AU - Siersma, Volkert

AU - Arpi, Magnus

AU - Hansen, Malene Plejdrup

PY - 2018/10/2

Y1 - 2018/10/2

N2 - OBJECTIVE: To investigate areas in need of quality improvement within the diagnostic process and antibiotic treatment of acute respiratory tract infections (RTIs) in Danish general practice by using quality indicators (QIs).DESIGN AND SETTING: During a 4-week period in winter 2017, a prospective registration of patients diagnosed with RTIs was conducted in general practice in two regions of Denmark.SUBJECTS: Throughout the registration period each patient with symptoms of an RTI was registered. Information about age, symptoms and findings, duration of symptoms, the use and result of clinical tests, allergy towards penicillin, referral to secondary care and the antibiotic given were recorded.MAIN OUTCOME MEASURES: Values and acceptable ranges for QIs focusing on the diagnostic process, the decision to prescribe antibiotics and the choice of antibiotics for patients with RTIs.RESULTS: Regarding the diagnostic process nearly all QIs for patients diagnosed with acute pharyngotonsillitis and pneumonia fell within the acceptable range. Contrarily, the diagnostic QIs for patients with acute otitis media and acute rhinosinusitis were outside the acceptable range. All indicators designed to measure overuse of antibiotics were outside the acceptable range and nearly all indicators assessing if patients were sufficiently treated fell within the acceptable range. QIs assessing use of the recommended type of antibiotic were only within the acceptable range for patients diagnosed with acute pharyngotonsillitis.CONCLUSION: The findings indicate an overuse of antibiotics for RTIs in Danish general practice. Especially management of acute rhinosinusitis and acute bronchitis should be targeted in future quality improvement projects.KEY POINTS: To improve antibiotic prescribing in general practice it is important to focus on both the diagnostic process and the prescribing patterns. The findings indicate an overuse of antibiotics for acute respiratory tract infections in Danish general practice. Especially the diagnostic process and antibiotic prescribing patterns for acute rhinosinusitis and acute bronchitis could benefit from future quality improvement interventions.

AB - OBJECTIVE: To investigate areas in need of quality improvement within the diagnostic process and antibiotic treatment of acute respiratory tract infections (RTIs) in Danish general practice by using quality indicators (QIs).DESIGN AND SETTING: During a 4-week period in winter 2017, a prospective registration of patients diagnosed with RTIs was conducted in general practice in two regions of Denmark.SUBJECTS: Throughout the registration period each patient with symptoms of an RTI was registered. Information about age, symptoms and findings, duration of symptoms, the use and result of clinical tests, allergy towards penicillin, referral to secondary care and the antibiotic given were recorded.MAIN OUTCOME MEASURES: Values and acceptable ranges for QIs focusing on the diagnostic process, the decision to prescribe antibiotics and the choice of antibiotics for patients with RTIs.RESULTS: Regarding the diagnostic process nearly all QIs for patients diagnosed with acute pharyngotonsillitis and pneumonia fell within the acceptable range. Contrarily, the diagnostic QIs for patients with acute otitis media and acute rhinosinusitis were outside the acceptable range. All indicators designed to measure overuse of antibiotics were outside the acceptable range and nearly all indicators assessing if patients were sufficiently treated fell within the acceptable range. QIs assessing use of the recommended type of antibiotic were only within the acceptable range for patients diagnosed with acute pharyngotonsillitis.CONCLUSION: The findings indicate an overuse of antibiotics for RTIs in Danish general practice. Especially management of acute rhinosinusitis and acute bronchitis should be targeted in future quality improvement projects.KEY POINTS: To improve antibiotic prescribing in general practice it is important to focus on both the diagnostic process and the prescribing patterns. The findings indicate an overuse of antibiotics for acute respiratory tract infections in Danish general practice. Especially the diagnostic process and antibiotic prescribing patterns for acute rhinosinusitis and acute bronchitis could benefit from future quality improvement interventions.

U2 - 10.1080/02813432.2018.1523996

DO - 10.1080/02813432.2018.1523996

M3 - Journal article

C2 - 30296885

SN - 0281-3432

VL - 36

SP - 372

EP - 379

JO - Scandinavian Journal of Primary Health Care

JF - Scandinavian Journal of Primary Health Care

IS - 4

ER -