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Title: Health Alliance for prudent antibiotic prescribing in patients with respiratory tract infections (HAPPY AUDIT) -impact of a non-randomised multifaceted intervention programme
Authors: Bjerrum, Lars
Munck, Anders
Gahrn-Hansen, Bente
Hansen, Malene Plejdrup
Jarbol, Dorte Ejg
Cordoba, Gloria
Llor, Carl
Cots, Josep Maria
Hernández, Silvia
González López-Valcárcel, Beatriz 
Pérez, Antonia
Caballero, Lidia
von der Heyde, Walter
Radzeviciene, Ruta
Jurgutis, Arnoldas
Reutskiy, Anatoliy
Egorova, Elena
Strandberg, Eva Lena
Ovhed, Ingvar
Mölstad, Sigvard
Vander Stichele, Robert
Benko, Ria
Vlahovic-Palcevski, Vera
Lionis, Christos
Rønning, Marit
UNESCO Clasification: 3212 Salud pública
Keywords: Antibiotic Resistance
Nordic Country
Clavulanic Acid
Bacterial Resistance
Antibiotic Prescribe
Issue Date: 2011
Journal: BMC Family Practice 
Abstract: Background: Excessive use of antibiotics is worldwide the most important reason for development of antimicrobial resistance. As antibiotic resistance may spread across borders, high prevalence countries may serve as a source of bacterial resistance for countries with a low prevalence. Therefore, bacterial resistance is an important issue with a potential serious impact on all countries. Initiatives have been taken to improve the quality of antibiotic prescribing in primary care, but only few studies have been designed to determine the effectiveness of multifaceted strategies across countries with different practice setting. The aim of this study was to evaluate the impact of a multifaceted intervention targeting general practitioners (GPs) and patients in six countries with different health organization and different prevalence of antibiotic resistance.Methods: GPs from two Nordic countries, two Baltic Countries and two Hispano-American countries registered patients with respiratory tract infections (RTIs) in 2008 and 2009. After first registration they received individual prescriber feedback and they were offered an intervention programme that included training courses, clinical guidelines, posters for waiting rooms, patient brochures and access to point of care tests (Strep A and C-Reactive Protein). Antibiotic prescribing rates were compared before and after the intervention.Results: A total of 440 GPs registered 47011 consultations; 24436 before the intervention (2008) and 22575 after the intervention (2009). After the intervention, the GPs significantly reduced the percentage of consultations resulting in an antibiotic prescription. In patients with lower RTI the GPs in Lithuania reduced the prescribing rate by 42%, in Russia by 25%, in Spain by 25%, and in Argentina by 9%. In patients with upper RTIs, the corresponding reductions in the antibiotic prescribing rates were in Lithania 20%, in Russia 15%, in Spain 9%, and in Argentina 5%.Conclusion: A multifaceted intervention programme targeting GPs and patients and focusing on improving diagnostic procedures in patients with RTIs may lead to a marked reduction in antibiotic prescribing. The pragmatic before-after design used may suffer from some limitations and the reduction in antibiotic prescribing could be influenced by factors not related to the intervention.
ISSN: 1471-2296
DOI: 10.1186/1471-2296-12-52
Source: BMC Family Practice [ISSN 1471-2296], v. 12, Article number 52, (Junio 2011)
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