Quality assessment of diagnosis and antibiotic treatment of infectious diseases in primary care: a systematic review of quality indicators

Abstract

ObjectiveTo identify existing quality indicators (QIs) for diagnosis and antibiotic treatment of patients with infectious diseases in primary care.DesignA systematic literature search was performed in PubMed and EMBASE. We included studies with a description of the development of QIs for diagnosis and antibiotic use in patients with infectious diseases in primary care. We extracted information about (1) type of infection; (2) target for quality assessment; (3) methodology used for developing the QIs; and (4) whether the QIs were developed for a national or international application. The QIs were organised into three categories: (1) QIs focusing on the diagnostic process; (2) QIs focusing on the decision to prescribe antibiotics; and (3) QIs concerning the choice of antibiotics.ResultsEleven studies were included in this review and a total of 130 QIs were identified. The majority (72%) of the QIs were focusing on choice of antibiotics, 22% concerned the decision to prescribe antibiotics, and few (6%) concerned the diagnostic process. Most QIs were either related to respiratory tract infections or not related to any type of infection. A consensus method (mainly the Delphi technique), based on either a literature study or national guidelines, was used for the development of QIs in all of the studies.ConclusionsThe small number of existing QIs predominantly focuses on the choice of antibiotics and is often drug-specific. There is a remarkable lack of diagnostic QIs. Future development of new QIs, especially disease-specific QIs concerning the diagnostic process, is needed.Key Points In order to improve the use of antibiotics in primary care, measurable instruments, such as quality indicators, are needed to assess the quality of care being provided.A total of 11 studies were found, including 130 quality indicators for diagnosis and antibiotic treatment of infectious diseases in primary care.The majority of the identified quality indicators were focusing on the choice of antibiotics and only a few concerned the diagnostic process.All quality indicators were developed by means of a consensus method and were often based on literature studies or guidelines.

Quality indicators assessing antibiotic use in the outpatient setting: a systematic review followed by an international multidisciplinary consensus procedure

“…A systematic review of QIs in primary care has been recently published by Saust et al 94 However, their literature search was less extensive than our systematic review. Moreover, they did not use a consensus procedure to validate the identified indicators.…”

“…Overall, our search identified a relatively low number of unique QIs targeting antibiotic use in the outpatient setting. Further investigation is needed to develop new QIs, including some focusing on diagnostic processes, 94 using an adequate methodology. 10 , 11 , 13 Assessing the relationship between process QIs and outcome indicators for appropriate antibiotic use (e.g.…”

Impact of Disease Prevalence Adjustment on Hospitalization Rates for Chronic Ambulatory Care–Sensitive Conditions in Germany

“…; Saust et al. ). While in the German health care system a structured set of quality indicators is mandatory for all German hospitals, the use of indicators for outpatient care shows potential for improvement (Albrecht, Loos, and Otten ; de Cruppé et al.…”

“…and faces challenges worldwide (Lester, Hannon, and Campbell 2011;Rushforth et al 2015;Saust et al 2016). While in the German health care system a structured set of quality indicators is mandatory for all German hospitals, the use of indicators for outpatient care shows potential for improvement (Albrecht, Loos, and Otten 2013;de Crupp e et al 2015;Hermes-Moll et al 2015).…”

Quality indicators for the diagnosis and antibiotic treatment of acute respiratory tract infections in general practice: a RAND Appropriateness Method

“…Existing QIs mainly focus on the choice of antibiotics; they are often drug-specific and fail to encompass the diagnostic process [11]. However, a rational decision about antibiotic prescribing is based on a proper diagnosis.…”