scholarly journals Antibiotic Prescription Rates After eVisits Versus Office Visits in Primary Care: Observational Study (Preprint)

2020 ◽  
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%; <i>P</i>&lt;.001) and respiratory symptoms (27/1724, 1.6%, vs 50/251, 19.9%; <i>P</i>&lt;.001), while no significant differences were noted comparing eVisits to office visits for dysuria (1016/1325, 76.7%, vs 143/196, 73.0%; <i>P</i>=.25). Guideline-recommended antibiotics were prescribed similarly following sore throat eVisits and office visits (163/169, 96.4%, vs 117/124, 94.4%; <i>P</i>=.39). eVisits for respiratory symptoms and dysuria were more often prescribed guideline-recommended antibiotics (26/27, 96.3%, vs 37/50, 74.0%; <i>P</i>=.02 and 1009/1016, 99.3%, vs 135/143, 94.4%; <i>P</i>&lt;.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

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

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

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

Antibiotics ◽  
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.

scholarly journals Figure Correction: Antibiotic Prescription Rates After eVisits Versus Office Visits in Primary Care: Observational Study (Preprint)

2021 ◽  
Author(s):  
Artin Entezarjou ◽  
Susanna Calling ◽  
Tapomita Bhattacharyya ◽  
Veronica Milos Nymberg ◽  
Lina Vigren ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Antibiotic Prescription ◽  
Office Visits ◽  
Prescription Rates

UNSTRUCTURED -

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

10.2196/34529 ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. e34529
Author(s):  
Artin Entezarjou ◽  
Susanna Calling ◽  
Tapomita Bhattacharyya ◽  
Veronica Milos Nymberg ◽  
Lina Vigren ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Antibiotic Prescription ◽  
Office Visits ◽  
Prescription Rates

scholarly journals Optimizing Antibiotic Prescribing for Acute Respiratory Tract Infection in German Primary Care: Study Protocol for Evaluation of the RESIST Program (Preprint)

2020 ◽  
Author(s):  
Christin Löffler ◽  
Antje Krüger ◽  
Anne Daubmann ◽  
Julia Iwen ◽  
Marc Biedermann ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Tract Infection ◽  
Statutory Health Insurance ◽  
Antibiotic Prescription ◽  
Acute Respiratory Tract Infection ◽  
Control Group ◽  
Antibiotic Prescribing ◽  
Prescription Rate ◽  
Before And After

BACKGROUND The emergence and increased spread of microbial resistance is a major challenge to all health care systems worldwide. In primary care, acute respiratory tract infection (ARTI) is the health condition most strongly related to antibiotic overuse. OBJECTIVE The RESIST program aims at optimizing antibiotic prescribing for ARTI in German primary care. By completing a problem-orientated online training course, physicians are motivated and empowered to utilize patient-centered doctor-patient communication strategies, including shared decision making, in the treatment of patients with ARTI. METHODS RESIST will be evaluated in the form of a nonrandomized controlled trial. Approximately 3000 physicians of 8 (out of 16) German federal states can participate in the program. Patient and physician data are retrieved from routine health care data. Physicians not participating in the program serve as controls, either among the 8 participating regional Associations of Statutory Health Insurance Physicians (control group 1) or among the remaining associations not participating in RESIST (control group 2). Antibiotic prescription rates before the intervention (T0: 2016, 1st and 2nd quarters of 2017) and after the intervention (T1: 3rd quarter of 2017 until 1st quarter of 2019) will be compared. The primary outcome measure is the overall antibiotic prescription rate for all patients insured with German statutory health insurance before and after provision of the online course. The secondary outcome is the antibiotic prescription rate for coded ARTI before and after the intervention. RESULTS RESIST is publicly funded by the Innovations funds of the Federal Joint Committee in Germany and was approved in December 2016. Recruitment of physicians is now completed, and a total of 2460 physicians participated in the intervention. Data analysis started in February 2020. CONCLUSIONS With approximately 3000 physicians participating in the program, RESIST is among the largest real-world interventions aiming at reducing inadequate antibiotic prescribing for ARTI in primary care. Long-term follow up of up to 21 months will allow for investigating the sustainability of the intervention. CLINICALTRIAL ISRCTN Registry ISRCTN13934505; http://www.isrctn.com/ISRCTN13934505 INTERNATIONAL REGISTERED REPORT RR1-10.2196/18648

Women and the Invention of Well Child Care

PEDIATRICS ◽  
1994 ◽  
Vol 94 (4) ◽  
pp. 527-531
Author(s):  
Jeffrey P. Baker
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Health Care ◽  
The United States ◽  
European Countries ◽  
Office Visits ◽  
Separate Spheres ◽  
Well Child Care ◽  
American Academy Of Pediatrics ◽  
Therapeutic Services

Few rituals better capture the preventive ethos of pediatrics than does the well child examination. In the United States, 25 to 50% of all general pediatric office visits involve the supervision of routine health care. Yet the same cannot be said for many European countries. In Britain, pediatricians function primarily as hospital-based specialists, with general practitioners and public health nurses providing most preventive care and immunizations. Indeed, an American Academy of Pediatrics (AAP) study of several European countries and Canada in 1990 noted that only a minority of the nations surveyed relied principally on pediatricians for primary care. In the European paradigm, preventive and therapeutic services are frequently administered in separate spheres.

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

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 &lt; 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 &lt; 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.

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

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.

scholarly journals Effect of unifaceted and multifaceted interventions on antibiotic prescription control for respiratory diseases: a systematic review of randomized controlled trials

2021 ◽  
Author(s):  
Chang Yue ◽  
Zhezhe Cui ◽  
Guanghong Yang ◽  
Xun He ◽  
Lei Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Respiratory Diseases ◽  
Antibiotic Prescription ◽  
Educational Interventions ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Short Term ◽  
Prescription Rates ◽  
Multifaceted Interventions

Abstract Background The global health system is improperly using antibiotics, particularly in the treatment of respiratory diseases. We aimed to examine the effectiveness of implementing a unifaceted and multifaceted intervention for unreasonable antibiotic prescriptions. Methods Relevant literature published in the databases of Pubmed, Embase, Science Direct, Cochrane Central Register of Controlled Trials (CENTRAL), Chinese Journal Full-text (CNKI) and Wanfang was searched. Data were independently filtered and extracted by two reviewers based on a pre-designed inclusion and exclusion criteria. The Cochrane collaborative bias risk tool was used to evaluate the quality of the included studies. Results A total of 1,074 relevant studies were obtained of which 69 were included in the systematic review. Fifty-nine studies reported positive results, that is, the primary results in the intervention groups were superior to those in the control groups. The remaining 10 studies had negative or partially negative results. In 22 studies the outcome variable was the antibiotic prescription rate with detailed reports of the number of prescriptions being further analyzed, of which 19 involved educational interventions for doctors, including: (1) Online training using email, web pages and webinar, (2) Antibiotic guidelines for information dissemination measures by email, postal or telephone reminder, (3) Training doctors in communication skills, (4) Short-term interactive educational seminars, and (5) Short-term field training sessions. Seventeen studies of interventions for health care workers also included: (6) Regular or irregular assessment/audit of antibiotic prescriptions, (7) Prescription recommendations from experts and peers delivered at a meeting or online, (8) Publicly reporting on doctors' antibiotic usage to patients, hospital administrators, and health authorities, (9) Monitoring/feedback prescribing behavior to general practices by email or poster, and (10) Studies involving patients and their families (n=10). Seventeen studies were rated as having a low risk of bias while five were rated as having a high risk of bias. Conclusion The combination of education, prescription audit, prescription recommendations from experts, public reporting, prescription feedback and patient or family member multifaceted interventions can effectively reduce antibiotic prescription rates in health care institutions. Moreover, adding multifaceted interventions to educational interventions can control antibiotic prescription rates and may be a more reasonable method. Registrations: This systematic review was registered in PROSPERO, registration number: CRD42020192560.

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