The Decline in Outpatient Antibiotic Use

Holstiege, Jakob; Schulz, Maike; Akmatov, Manas K.; Kern, Winfried V.; Steffen, Annika; Bätzing, Jörg

doi:10.3238/arztebl.2020.0679

Cited by 31 publications

(34 citation statements)

References 30 publications

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“…Particularly, the determinant to receive feedback from colleagues is mirrored in our data. Since antibiotic prescribing rates have been decreasing in German primary care in recent years [ 3 , 25 , 26 , 27 , 28 ] and the observed participant prescribing rates for acute non-complicated infections were moderate prior to the ARena project [ 29 ], outcome analyses based on the claims data will inform about the extent of effects that were possible to be achieved by ARena, particularly regarding the guideline-conform use of recommended antibiotics.…”

Section: Discussionmentioning

confidence: 99%

Fostering Appropriate Antibiotic Use in a Complex Intervention: Mixed-Methods Process Evaluation Alongside the Cluster-Randomized Trial ARena

et al. 2020

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The cluster randomized trial ARena (sustainable reduction of antibiotic-induced antimicrobial resistance, 2017–2020) promoted appropriate use of antibiotics for acute non-complicated infections in primary care networks (PCNs) in Germany. A process evaluation assessed determinants of practice and explored factors associated with antibiotic prescribing patterns. This work describes its findings on uptake and impacts of the complex intervention program and indicates potential implementation into routine care. In a nested mixed-methods approach, a three-wave study-specific survey for participating physicians and medical assistants assessed potential impacts and uptake of the complex intervention program. Stakeholders received a one-time online questionnaire to reflect on network-related aspects. Semi-structured, open-ended interviews, with a purposive sample of physicians, medical assistants and stakeholders, explored program component acceptance for daily practice and perceived sustainability of intervention component effects. Intervention components were perceived to be smoothly integrable into practice routines. The highest uptake was reported for educational components: feedback reports, background information, e-learning modules and disease-specific quality circles (QCs). Participation in PCNs was seen as the motivational factor for guideline-oriented patient care and adoption of new routines. Future approaches to fostering appropriate antibiotics use by targeting health literacy competencies and clinician’s therapy decisions should combine evidence-based information sources, audit and feedback reports and QCs.

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Section: Discussionmentioning

confidence: 99%

Fostering Appropriate Antibiotic Use in a Complex Intervention: Mixed-Methods Process Evaluation Alongside the Cluster-Randomized Trial ARena

et al. 2020

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“…Therefore, the use of both antibiotic groups should be monitored with particular vigilance. In all German regions, cephalosporins belong to the antibiotic groups which are most commonly prescribed, although this is not consistent with guidelines for the treatment of common infections [14,17,19]. According to Schulz et al, prescription rates of antibiotics for pharyngitis/tonsillitis, scarlet fever, pneumonia, otitis media, and urinary tract infections (UTI) and the proportion of fluoroquinolones for the treatment of common infections were higher in Germany in 2009 compared to the recommendation by the European Surveillance of Antimicrobial Consumption (ESAC) [20].…”

Section: Introductionmentioning

confidence: 89%

“…It has been shown that overall use of antibiotics has decreased in Germany from 2010-2018 [14]. Variation in ambulatory antibiotic prescribing between the 16 federal states in 2003 was substantial, although the reasons for these differences are not fully understood [14,15].…”

Section: Introductionmentioning

confidence: 99%

“…According to Schulz et al, prescription rates of antibiotics for pharyngitis/tonsillitis, scarlet fever, pneumonia, otitis media, and urinary tract infections (UTI) and the proportion of fluoroquinolones for the treatment of common infections were higher in Germany in 2009 compared to the recommendation by the European Surveillance of Antimicrobial Consumption (ESAC) [20]. However, the use of fluoroquinolones and of cephalosporins has decreased from 2010-2018 in nearly all regions across Germany [14,19].…”

Section: Introductionmentioning

confidence: 99%

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Quality Appraisal of Ambulatory Oral Cephalosporin and Fluoroquinolone Use in the 16 German Federal States from 2014–2019

et al. 2021

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Background: Despite concerns about causing bacterial resistance and serious side effects, oral cephalosporins and fluoroquinolones are still frequently prescribed in Germany. We aimed to test a method for the detection of regional quality differences in the use of oral cephalosporins and fluoroquinolones and to apply this to the German federal states. Methods: Use of antibiotics from 2014–2019 was analyzed using dispensing data from community pharmacies claimed to the statutory health insurance (SHI) funds. Quality of regional antibiotic use in 2019 was assessed by calculating indicators based on defined daily doses per 1000 SHI-insured persons per day (DID). Oral cephalosporin and fluoroquinolone use was followed by linear regression analyses. Results: The method used was suitable to find meaningful quality differences in ambulatory oral cephalosporin and fluoroquinolone use between the German federal states. In 2019, DID varied from 1.62 in Brandenburg to 3.17 in Rhineland-Palatinate for cephalosporins and from 0.47 in Brandenburg to 0.89 in Saarland for fluoroquinolones. The city-states Hamburg, Bremen, and Berlin showed highest quality with the applied indicator set. From 2014–2019, a significant decrease in utilization of oral cephalosporins was found in all federal states. During 2017–2019, all states showed a significant decline of fluoroquinolone use.

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“…Particularly, the determinant to receive feedback from colleagues is mirrored in our data. Since antibiotic prescribing rates have been decreasing in German primary care in recent years [21][22][23][24][25] and the observed participant prescribing rates for acute non-complicated infections were moderate prior to the ARena project [26], outcome analyses based on the claims data will inform about the extent of effects which were possible to be achieved by ARena, particularly regarding the guideline-conform use of recommended antibiotics.…”

Section: Comparison To Prior Researchmentioning

confidence: 99%

Fostering Appropriate Antibiotic Use in a Complex Intervention: Mixed-Methods Process Evaluation Alongside the Cluster-Randomized Trial ARena

Poß-Doering¹,

Kühn²,

Kamradt³

et al. 2020

Preprint

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The cluster randomized trial ARena (Sustainable reduction of antibiotic-induced antimicrobial resistance, 2017-2020) promoted the appropriate use of antibiotics for acute non-complicated infections in primary care networks (PCNs) in Germany. A process evaluation aimed to provide insights into determinants of practice and explored factors associated with antibiotic prescribing patterns. In a nested mixed-methods approach, a three-waves survey used study-specific questionnaires for participating physicians and medical assistants to assess potential impacts and uptake of the complex intervention program. Stakeholders received a one-time online questionnaire to reflect on network-related aspects. Semi-structured, open-ended interviews with a purposive sample of physicians, medical assistants and stakeholders explored aspects regarding the acceptance of the program components for daily practice and the perceived sustainability of intervention component effects. The intervention components were perceived to be smoothly integrable into practice routines. The highest uptake was reported for the educational components: feedback reports, background information, e-learning modules, and disease specific quality circles. Participation in PCNs was seen as motivational factor for guideline-oriented patient care and the adoption of new routines Future approaches to fostering appropriate use of antibiotics by targeting health literacy competencies and clinician’s therapy decisions should combine evidence-based information sources, audit and feedback reports and QCs.

show abstract

The Decline in Outpatient Antibiotic Use

Cited by 31 publications

References 30 publications

Fostering Appropriate Antibiotic Use in a Complex Intervention: Mixed-Methods Process Evaluation Alongside the Cluster-Randomized Trial ARena

Fostering Appropriate Antibiotic Use in a Complex Intervention: Mixed-Methods Process Evaluation Alongside the Cluster-Randomized Trial ARena

Quality Appraisal of Ambulatory Oral Cephalosporin and Fluoroquinolone Use in the 16 German Federal States from 2014–2019

Fostering Appropriate Antibiotic Use in a Complex Intervention: Mixed-Methods Process Evaluation Alongside the Cluster-Randomized Trial ARena

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