Impact of changing reimbursement criteria on the use of fluoroquinolones in Belgium

Vermeulen, Helene; Coenen, Samuel; Hens, Niel; Bruyndonckx, Robin

doi:10.1093/jac/dkab255

Cited by 8 publications

(7 citation statements)

References 26 publications

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“…We conclude that it is primarily the use of fluoroquinolones that needs to be scaled down. Adherence to guidelines showed an improvement over the timeframe of our study, which could be attributed to the implementation of stricter reimbursement criteria for fluoroquinolones in 2018 as was shown by others [5].…”

Section: Discussionsupporting

confidence: 75%

“…A study on data collected in 2016-2018 among five Belgian OOH primary care services found only 69% of patients with LUTI receiving the guideline recommended AB [3]. A study on similar data extracted from the same 'iCAREdata' database [4] identified a radical decrease in the prescription of fluoroquinolones after modification of the reimbursement criteria on 1 May 2018 [5].…”

Section: Introductionmentioning

confidence: 99%

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Differences in antibiotic prescribing quality in Belgian out-of-hours primary care services

Man

Remmen

Philips

2022

Acta Clinica Belgica

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ObjectivesThis study aims to compare trends in antibiotic prescribing behaviour for lower urinary tract infections among different out-of-hours primary care services. MethodsCross-sectional study using routine prescription data extracted from electronic health records from six out-of-hours services. The study population included 5888 cases diagnosed with an uncomplicated lower urinary tract infection from 2016 to 2020.Prescriptions were assessed based on the national guidelines. ResultsConsidering the total study period, an antibiotic was prescribed in 98.9% of cases. Among these cases, 55.0% was prescribed a guideline recommended antibiotic, 21.0% was prescribed fosfomycin, 17.4% was prescribed a quinolone and 1.8% was prescribed more than one antibiotic. Guideline recommended prescribing improved substantially over time. However, there were significant differences among out-ofhours services in terms of proportion over the total study period (between 49.0% and 66.7%) as well as in terms of time-trend pattern. ConclusionSubstantial differences among out-of-hours services suggest a potential for further improvement in the quality of antibiotic prescribing. Monitoring prescribing behaviour per out-of-hours primary care service can guide focused interventions.

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Section: Discussionsupporting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Differences in antibiotic prescribing quality in Belgian out-of-hours primary care services

Man

Remmen

Philips

2022

Acta Clinica Belgica

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“…This sudden drop was related to changes in reimbursement criteria of fluoroquinolones in Belgium. As of May 2018, fluoroquinolones, including ofloxacin, ciprofloxacin, norfloxacin, levofloxacin and moxifloxacin, are no longer reimbursed for the treatment of respiratory tract infections or uncomplicated urinary tract infections [ 21 ]. In the Netherlands, a drop in prescription rates in the regression analyses could be observed after implementation of regulatory interventions.…”

Section: Discussionmentioning

confidence: 99%

Impact of European Union Label Changes for Fluoroquinolone-Containing Medicinal Products for Systemic and Inhalation Use: Post-Referral Prescribing Trends

Flach

Lysen³

et al. 2023

Drug Saf

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Introduction Concerns of the persistence and severity of the adverse effects of fluoroquinolones, mainly involving the nervous system, muscles and joints, resulted in the 2018 referral procedure led by the European Medicines Agency (EMA). They advised to stop prescribing fluoroquinolones for infections of mild severity or of a presumed self-limiting course and for prevention of infections, plus to restrict prescriptions in cases of milder infections where other treatment options are available, and restrict in at-risk populations. We aimed to examine whether the impact of EMA regulatory interventions implemented throughout 2018–2019 had an impact on fluoroquinolone prescribing rates. Methods A retrospective population-based cohort study was conducted using electronic health care records from six European countries between 2016 and 2021. We analysed monthly incident fluoroquinolone use rates overall and for each fluoroquinolone active substance through flexible modelling via segmented regression to detect time points of trend changes, in monthly percentage change (MPC). Results The incidence of fluoroquinolone use ranged from 0.7 to 8.0/1000 persons per month over all calendar years. While changes in fluoroquinolone prescriptions were observed over time across countries, these were inconsistent and did not seem to be temporally related to EMA interventions (e.g., Belgium: February/May 2018, MPC − 33.3%, 95% confidence interval [CI] − 35.9 to − 30.7; Germany: February/May 2019, MPC − 12.6%, 95% CI − 13.7 to − 11.6]; UK: January/April 2016, MPC − 4.9%, 95% CI − 6.2 to − 3.6). Conclusion The regulatory action associated with the 2018 referral did not seem to have relevant effects on fluoroquinolone prescribing in primary care. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-023-01286-4.

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“…Our results also appear relevant more broadly in Europe, where quinolone prescription rates vary from 3% in Sweden to 22% in Belgium 27. Belgium has reported large reductions because of changes in reimbursement criteria 28…”

Section: Discussionmentioning

confidence: 51%

Effects of a multimodal intervention in primary care to reduce second line antibiotic prescriptions for urinary tract infections in women: parallel, cluster randomised, controlled trial

Schmiemann,

Greser,

Maun

et al. 2023

BMJ

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Objectives To evaluate whether a multimodal intervention in general practice reduces the proportion of second line antibiotic prescriptions and the overall proportion of antibiotic prescriptions for uncomplicated urinary tract infections in women. Design Parallel, cluster randomised, controlled trial. Setting General practices in five regions in Germany. Data were collected between 1 April 2021 and 31 March 2022. Participants General practitioners from 128 randomly assigned practices. Interventions Multimodal intervention consisting of guideline recommendations for general practitioners and patients, provision of regional data for antibiotic resistance, and quarterly feedback, which included individual first line and second line proportions of antibiotic prescribing, benchmarking with regional or supra-regional practices, and telephone counselling. Participants in the control group received no information on the intervention. Main outcome measures Primary outcome was the proportion of second line antibiotics prescribed by general practices, in relation to all antibiotics prescribed, for uncomplicated urinary tract infections after one year between the intervention and control group. General practices were randomly assigned in blocks (1:1), with a block size of four, into the intervention or control group using SAS version 9.4; randomisation was stratified by region. The secondary outcome was the prescription proportion of all antibiotics, relative within all cases (instances of UTI diagnosis), for the treatment of urinary tract infections after one year between the groups. Adverse events were assessed as exploratory outcomes. Results 110 practices with full datasets identified 10 323 cases during five quarters (ie, 15 months). The mean proportion of second line antibiotics prescribed was 0.19 (standard deviation 0.20) in the intervention group and 0.35 (0.25) in the control group after 12 months. After adjustment for preintervention proportions, the mean difference was −0.13 (95% confidence interval −0.21 to −0.06, P<0.001). The overall proportion of all antibiotic prescriptions for urinary tract infections over 12 months was 0.74 (standard deviation 0.22) in the intervention and 0.80 (0.15) in the control group with a mean difference of −0.08 (95% confidence interval −0.15 to −0.02, P<0.029). No differences were noted in the number of complications (ie, pyelonephritis, admission to hospital, or fever) between the groups. Conclusions The multimodal intervention in general practice significantly reduced the proportion of second line antibiotics and all antibiotic prescriptions for uncomplicated urinary tract infections in women. Trial registration German Clinical Trials Register (DRKS), DRKS00020389

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Impact of changing reimbursement criteria on the use of fluoroquinolones in Belgium

Cited by 8 publications

References 26 publications

Differences in antibiotic prescribing quality in Belgian out-of-hours primary care services

Differences in antibiotic prescribing quality in Belgian out-of-hours primary care services

Impact of European Union Label Changes for Fluoroquinolone-Containing Medicinal Products for Systemic and Inhalation Use: Post-Referral Prescribing Trends

Effects of a multimodal intervention in primary care to reduce second line antibiotic prescriptions for urinary tract infections in women: parallel, cluster randomised, controlled trial

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