Antibiotic Prescribing Quality in Out-of-Hours Primary Care and Critical Appraisal of Disease-Specific Quality Indicators

Abstract

Outpatient antibiotic use in Belgium is among the highest in Europe. The most common reason for an encounter in out-of-hours (OOH) primary care is an infection. In this study, we assessed all consultations from July 2016 to June 2018 at five OOH services. We described antibiotic prescribing by diagnosis, calculated disease-specific antibiotic prescribing quality indicators’ (APQI) values and critically appraised these APQI. We determined that 111,600 encounters resulted in 26,436 (23.7%) antibiotic prescriptions. The APQI diagnoses (i.e., bronchitis, upper respiratory infection, cystitis, tonsillitis, sinusitis, otitis media, and pneumonia) covered 14,927 (56.7%) antibiotic prescriptions. Erysipelas (1344 (5.1%)) and teeth/gum disease (982 (3.7%)) covered more prescriptions than sinusitis or pneumonia. Over 75% of patients with tonsillitis and over 50% with bronchitis, sinusitis, and otitis media were prescribed an antibiotic. Only for otitis media the choice of antibiotic was near the acceptable range. Over 10% of patients with bronchitis or pneumonia and over 25% of female patients with an acute cystitis received quinolones. The APQI cover the diagnoses for only 57% of all antibiotic prescriptions. As 5.1% and 3.7% of antibiotic prescriptions are made for erysipelas and teeth/gum disease, respectively, we propose to add these indications when assessing antibiotic prescribing quality in OOH primary care.

Prevalence and Antibiotic Resistance of ESKAPE Pathogens Isolated in the Emergency Department of a Tertiary Care Teaching Hospital in Hungary: A 5-Year Retrospective Survey

“…With high rates of patient turn-over, variability in staffing and a subsequent lack of ‘continuity of care’ are important challenges in facilitating prudent use of antibiotics [ 23 ]. Out-of-hour services and EDs has been associated with lower threshold for antibiotic prescribing and suboptimal antibiotic choice [ 24 , 25 , 26 , 27 , 28 ]. Antibiotic treatments initiated on EDs are almost exclusively empirical.…”

Diagnosis-linked antibiotic prescribing in Swedish primary care - a comparison between in-hours and out-of-hours

“…In a qualitative study from Belgium, the physicians reported that the threshold for prescribing antibiotics was lower during OOH, but the choice of antibiotics was the same [11]. A more recent Belgian OOH study showed a high antibiotic prescribing rate for all indications, a high rate of not using recommended antibiotics, and an overuse of quinolones [12]. However, a Dutch study found the prescribing quality to be appropriate, and the higher rates of prescribing in OOH were explained by a different population of presenting patients [13].…”

Understanding General Practitioners’ Antibiotic Prescribing Decisions in Out-of-Hours Primary Care: A Video-Elicitation Interview Study

“…Out-of-hours (OOH) care is particularly relevant in this respect [2]. During OOH GPs are mostly confronted with patients with infections [3], and antibiotic prescribing quality shows room for improvement [4][5][6][7]. In previous research we learned that GPs feel that the OOH context influences their prescribing behaviour, because of their different professional role, first and only contact with this patient, time pressure, etc [8,9].…”