Figure Correction: Antibiotic Prescription Rates After eVisits Versus Office Visits in Primary Care: Observational Study

BACKGROUND Direct-to-consumer telemedicine is an increasingly used modality to access primary care. Previous research on assessment using synchronous virtual visits showed mixed results regarding antibiotic prescription rates, and research on assessment using asynchronous chat-based eVisits is lacking. OBJECTIVE The goal of the research was to investigate if eVisit management of sore throat, other respiratory symptoms, or dysuria leads to higher rates of antibiotic prescription compared with usual management using physical office visits. METHODS Data from 3847 eVisits and 759 office visits for sore throat, dysuria, or respiratory symptoms were acquired from a large private health care provider in Sweden. Data were analyzed to compare antibiotic prescription rates within 3 days, antibiotic type, and diagnoses made. For a subset of sore throat visits (n=160 eVisits, n=125 office visits), Centor criteria data were manually extracted and validated. RESULTS Antibiotic prescription rates were lower following eVisits compared with office visits for sore throat (169/798, 21.2%, vs 124/312, 39.7%; P<.001) and respiratory symptoms (27/1724, 1.6%, vs 50/251, 19.9%; P<.001), while no significant differences were noted comparing eVisits to office visits for dysuria (1016/1325, 76.7%, vs 143/196, 73.0%; P=.25). Guideline-recommended antibiotics were prescribed similarly following sore throat eVisits and office visits (163/169, 96.4%, vs 117/124, 94.4%; P=.39). eVisits for respiratory symptoms and dysuria were more often prescribed guideline-recommended antibiotics (26/27, 96.3%, vs 37/50, 74.0%; P=.02 and 1009/1016, 99.3%, vs 135/143, 94.4%; P<.001, respectively). Odds ratios of antibiotic prescription following office visits compared with eVisits after adjusting for age and differences in set diagnoses were 2.94 (95% CI 1.99-4.33), 11.57 (95% CI 5.50-24.32), 1.01 (95% CI 0.66-1.53), for sore throat, respiratory symptoms, and dysuria, respectively. CONCLUSIONS The use of asynchronous eVisits for the management of sore throat, dysuria, and respiratory symptoms is not associated with an inherent overprescription of antibiotics compared with office visits. CLINICALTRIAL ClinicalTrials.gov NCT03474887; https://clinicaltrials.gov/ct2/show/NCT03474887

Download Full-text

Antibiotic Prescription Rates After eVisits Versus Office Visits in Primary Care: Observational Study

JMIR Medical Informatics ◽

10.2196/25473 ◽

2021 ◽

Vol 9 (3) ◽

pp. e25473

Author(s):

Artin Entezarjou ◽

Susanna Calling ◽

Tapomita Bhattacharyya ◽

Veronica Milos Nymberg ◽

Lina Vigren ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Sore Throat ◽

Respiratory Symptoms ◽

Antibiotic Prescription ◽

Private Health Care ◽

Office Visits ◽

Direct To Consumer ◽

Virtual Visits ◽

Prescription Rates

Background Direct-to-consumer telemedicine is an increasingly used modality to access primary care. Previous research on assessment using synchronous virtual visits showed mixed results regarding antibiotic prescription rates, and research on assessment using asynchronous chat-based eVisits is lacking. Objective The goal of the research was to investigate if eVisit management of sore throat, other respiratory symptoms, or dysuria leads to higher rates of antibiotic prescription compared with usual management using physical office visits. Methods Data from 3847 eVisits and 759 office visits for sore throat, dysuria, or respiratory symptoms were acquired from a large private health care provider in Sweden. Data were analyzed to compare antibiotic prescription rates within 3 days, antibiotic type, and diagnoses made. For a subset of sore throat visits (n=160 eVisits, n=125 office visits), Centor criteria data were manually extracted and validated. Results Antibiotic prescription rates were lower following eVisits compared with office visits for sore throat (169/798, 21.2%, vs 124/312, 39.7%; P<.001) and respiratory symptoms (27/1724, 1.6%, vs 50/251, 19.9%; P<.001), while no significant differences were noted comparing eVisits to office visits for dysuria (1016/1325, 76.7%, vs 143/196, 73.0%; P=.25). Guideline-recommended antibiotics were prescribed similarly following sore throat eVisits and office visits (163/169, 96.4%, vs 117/124, 94.4%; P=.39). eVisits for respiratory symptoms and dysuria were more often prescribed guideline-recommended antibiotics (26/27, 96.3%, vs 37/50, 74.0%; P=.02 and 1009/1016, 99.3%, vs 135/143, 94.4%; P<.001, respectively). Odds ratios of antibiotic prescription following office visits compared with eVisits after adjusting for age and differences in set diagnoses were 2.94 (95% CI 1.99-4.33), 11.57 (95% CI 5.50-24.32), 1.01 (95% CI 0.66-1.53), for sore throat, respiratory symptoms, and dysuria, respectively. Conclusions The use of asynchronous eVisits for the management of sore throat, dysuria, and respiratory symptoms is not associated with an inherent overprescription of antibiotics compared with office visits. Trial Registration ClinicalTrials.gov NCT03474887; https://clinicaltrials.gov/ct2/show/NCT03474887

Download Full-text

571Effect of a computer network-based feedback program on antibiotic prescription rates of primary care physicians

International Journal of Epidemiology ◽

10.1093/ije/dyab168.118 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Yue Chang

Keyword(s):

Primary Care ◽

Antibiotic Resistance ◽

Computer Network ◽

Antibiotic Prescription ◽

Intervention Group ◽

Control Group ◽

P Value ◽

Prescription Rate ◽

Feedback Intervention ◽

Prescription Rates

Abstract Background Antibiotic overuse is one of the major prescription problems in rural China and a major risk factor for antibiotic resistance. Low antibiotic prescription rates can effectively reduce the risk of antibiotic resistance. Methods A cluster randomized crossover open controlled trial was conducted in 31 hospitals. These hospitals were randomly allocated to two groups to receive the intervention for three months followed by no intervention for three months in a random sequence. The feedback intervention information, which displayed the physicians’ antibiotic prescription rates and ranking, was updated every 10 days. The primary outcome was the 10-day antibiotic prescription rate of the physicians. Results There were 82 physicians in group 1 (intervention first followed by control) and 81 in group 2 (control first followed by intervention). Baseline comparison showed no significant difference in antibiotic prescription rate between the two groups (30.8% vs 35.2%, P-value = 0.07). At the crossover point, the relative reduction in antibiotic prescription rate was significantly higher among physicians in the intervention group than in the control group (33.1% vs 20.3%, P-value < 0.001). After a further 3 months, the rate of decline in antibiotic prescriptions was also significantly greater in the intervention group compared to the control group (14.2% vs 4.6%, P-value < 0.001). Conclusions A computer network-based feedback intervention can significantly reduce the antibiotic prescription rates of primary care outpatient physicians. Key messages The feedback intervention continuously affected their prescription behavior for up to six months.

Download Full-text

Baseline assessment of antibiotics prescribing for acute, non-complicated infections in primary care in Germany in the cluster randomized trial ARena

10.21203/rs.3.rs-59028/v1 ◽

2020 ◽

Author(s):

Regina Poss-Doering ◽

Dorothea Weber ◽

Martina Kamradt ◽

Edith Andres ◽

Petra Kaufmann-Kolle ◽

...

Keyword(s):

Primary Care ◽

General Practitioners ◽

Antibiotic Prescription ◽

Treatment Options ◽

Inappropriate Prescribing ◽

Cluster Randomized Trial ◽

Female Gender ◽

Reference Groups ◽

Prescription Rates ◽

To Receive

Abstract BackgroundAntimicrobial resistance is fueled by inappropriate prescribing and use of antibiotics. Global and national strategies support rational and adequate use of antibiotics to retain treatment options and fight resistances. In Germany, the ARena project (Sustainable reduction of antibiotic-induced antimicrobial resistance) was intended to promote the rational and appropriate use of antibiotics for acute non-complicated infections by addressing physicians, care teams and patients through multiple interacting interventions. This paper presents patterns of antibiotics prescribing for patients with acute non-complicated infections in participating primary care networks prior to the start of the ARena project, explores variation across subgroups of patients and draws comparisons to reference groups which represent standard care. MethodsIn mixed logistic regression models, we explored factors associated with the proportion of patients with acute non-complicated infections consulting primary care practices who received an antibiotic prescription. Secondary outcomes concerned the prescription of different types of antibiotics. Descriptive methods were used to summarize the data referring to primary care networks, reference groups, and subgroups. ResultsAcross all observed cases, antibiotic prescription rates were 31.7% in reference groups and 32.0% in primary care networks. Being the largest group of physicians observed, General practitioners prescribed antibiotics more frequently than other medical specialist groups (otolaryngologists vs. General practitioners OR=0.465 CI=[0.302; 0.719], p<0.001, pediatricians vs. General practitioners: OR=0.369 CI=[0.135; 1.011], p=0.053). Quinolone prescription rates were moderate (8.1% in reference groups and 9.9% in primary care networks). Patients with comorbidities had a higher likelihood of receiving an antibiotic and quinolone prescription and were less likely to receive a recommended substance. Younger patients were less likely to receive antibiotics (OR=0.771 CI=[0.636; 0.933], p=0.008). Female gender was associated with higher rates of antibiotic prescriptions compared to males (OR=1.293 CI=[1.201, 1.392], p<0.001).Conclusion Prior to the ARena project, observed antibiotic prescription rates for acute non-complicated infections were moderate, but there was still room for improvement. The use of recommended substances was low which indicates a need for creating stronger awareness of guideline-conform use of antibiotics.

Download Full-text

Changing antibiotic prescribing practices in outpatient primary care settings in China: Study protocol for a health information system-based cluster-randomised crossover controlled trial

PLoS ONE ◽

10.1371/journal.pone.0259065 ◽

2022 ◽

Vol 17 (1) ◽

pp. e0259065

Author(s):

Yue Chang ◽

Yuanfan Yao ◽

Zhezhe Cui ◽

Guanghong Yang ◽

Duan Li ◽

...

Keyword(s):

Primary Care ◽

Antibiotic Prescription ◽

Intervention Group ◽

Control Group ◽

Antibiotic Prescribing ◽

Prescription Rate ◽

Feedback Intervention ◽

Primary Care Settings ◽

Cluster Randomised ◽

Prescription Rates

Background The overuse and abuse of antibiotics is a major risk factor for antibiotic resistance in primary care settings of China. In this study, the effectiveness of an automatically-presented, privacy-protecting, computer information technology (IT)-based antibiotic feedback intervention will be evaluated to determine whether it can reduce antibiotic prescribing rates and unreasonable prescribing behaviours. Methods We will pilot and develop a cluster-randomised, open controlled, crossover, superiority trial. A total of 320 outpatient physicians in 6 counties of Guizhou province who met the standard will be randomly divided into intervention group and control group with a primary care hospital being the unit of cluster allocation. In the intervention group, the three components of the feedback intervention included: 1. Artificial intelligence (AI)-based real-time warnings of improper antibiotic use; 2. Pop-up windows of antibiotic prescription rate ranking; 3. Distribution of educational manuals. In the control group, no form of intervention will be provided. The trial will last for 6 months and will be divided into two phases of three months each. The two groups will crossover after 3 months. The primary outcome is the 10-day antibiotic prescription rate of physicians. The secondary outcome is the rational use of antibiotic prescriptions. The acceptability and feasibility of this feedback intervention study will be evaluated using both qualitative and quantitative assessment methods. Discussion This study will overcome limitations of our previous study, which only focused on reducing antibiotic prescription rates. AI techniques and an educational intervention will be used in this study to effectively reduce antibiotic prescription rates and antibiotic irregularities. This study will also provide new ideas and approaches for further research in this area. Trial registration ISRCTN, ID: ISRCTN13817256. Registered on 11 January 2020.

Download Full-text

General and URTI-specific antibiotic prescription rates in a Malaysian primary care setting

International Journal of Antimicrobial Agents ◽

10.1016/j.ijantimicag.2004.06.015 ◽

2004 ◽

Vol 24 (5) ◽

pp. 496-501 ◽

Cited By ~ 13

Author(s):

C.L. Teng ◽

F.I. Achike ◽

K.L. Phua ◽

Y. Norhayati ◽

M.I. Nurjahan ◽

...

Keyword(s):

Primary Care ◽

Care Setting ◽

Primary Care Setting ◽

Antibiotic Prescription ◽

Prescription Rates

Download Full-text

Variation in antibiotic prescription rates in febrile children presenting to emergency departments across Europe (MOFICHE): A multicentre observational study

PLoS Medicine ◽

10.1371/journal.pmed.1003208 ◽

2020 ◽

Vol 17 (8) ◽

pp. e1003208 ◽

Cited By ~ 1

Author(s):

Nienke N. Hagedoorn ◽

Dorine M. Borensztajn ◽

Ruud Nijman ◽

Anda Balode ◽

Ulrich von Both ◽

...

Keyword(s):

Observational Study ◽

Emergency Departments ◽

Antibiotic Prescription ◽

Prescription Rates

Download Full-text

Impact of the COVID-19 Pandemic on Antibiotic Prescribing for Common Infections in The Netherlands: A Primary Care-Based Observational Cohort Study

Antibiotics ◽

10.3390/antibiotics10020196 ◽

2021 ◽

Vol 10 (2) ◽

pp. 196

Author(s):

Alma C. van de Pol ◽

Josi A. Boeijen ◽

Roderick P. Venekamp ◽

Tamara Platteel ◽

Roger A. M. J. Damoiseaux ◽

...

Keyword(s):

Infectious Disease ◽

Primary Care ◽

Health Care ◽

Antibiotic Prescription ◽

Antibiotic Use ◽

Antibiotic Prescribing ◽

Skin Infections ◽

Prescription Rates ◽

Ear Infections ◽

Disease Entities

In 2020, the COVID-19 pandemic brought dramatic changes in the delivery of primary health care across the world, presumably changing the number of consultations for infectious diseases and antibiotic use. We aimed to assess the impact of the pandemic on infections and antibiotic prescribing in Dutch primary care. All patients included in the routine health care database of the Julius General Practitioners’ Network were followed from March through May 2019 (n = 389,708) and March through May 2020 (n = 405,688). We extracted data on consultations for respiratory/ear, urinary tract, gastrointestinal and skin infections using the International Classification of Primary Care (ICPC) codes. These consultations were combined in disease episodes and linked to antibiotic prescriptions. The numbers of infectious disease episodes (total and those treated with antibiotics), complications, and antibiotic prescription rates (i.e., proportion of episodes treated with antibiotics) were calculated and compared between the study periods in 2019 and 2020. Fewer episodes were observed during the pandemic months than in the same months in 2019 for both the four infectious disease entities and complications such as pneumonia, mastoiditis and pyelonephritis. The largest decline was seen for gastrointestinal infections (relative risk (RR), 0.54; confidence interval (CI), 0.51 to 0.58) and skin infections (RR, 0.71; CI, 0.67 to 0.75). The number of episodes treated with antibiotics declined as well, with the largest decrease seen for respiratory/ear infections (RR, 0.54; CI, 0.52 to 0.58). The antibiotic prescription rate for respiratory/ear infections declined from 21% to 13% (difference −8.0% (CI, −8.8 to −7.2)), yet the prescription rates for other infectious disease entities remained similar or increased slightly. The decreases in primary care infectious disease episodes and antibiotic use were most pronounced in weeks 15–19, mid-COVID-19 wave, after an initial peak in respiratory/ear infection presentation in week 11, the first week of lock-down. In conclusion, our findings indicate that the COVID-19 pandemic has had profound effects on the presentation of infectious disease episodes and antibiotic use in primary care in the Netherlands. Consequently, the number of infectious disease episodes treated with antibiotics decreased. We found no evidence of an increase in complications.

Download Full-text