TY - JOUR
T1 - Antibiotic prescribing during office hours and out-of-hours
T2 - a comparison of quality and quantity in primary care in the Netherlands
AU - Debets, Vera Ec
AU - Verheij, Theo Jm
AU - van der Velden, Alike W
N1 - Publisher Copyright:
© 2017 British Journal of General Practice.
PY - 2017/3
Y1 - 2017/3
N2 - BACKGROUND: Unnecessary and non-first-choice antibiotic prescribing is a significant problem in primary care. It is often argued that irrational prescribing is higher during out-of-hours (OOH) consultations.AIM: To obtain insight into the quantity and quality of OOH antibiotic prescribing for commonly presented infectious diseases.DESIGN AND SETTING: Two two-way comparisons of 1) nationally dispensed antibiotics during office hours and OOH care, using data from the Dutch Foundation of Pharmaceutical Statistics, and 2) regional prescribing quality data from 45 primary care practices from Utrecht and its vicinity, and two large OOH services in Utrecht and Woerden.METHOD: From the national data, yearly dispensed antibiotics were analysed per prescriber type, with respect to time (office hours or OOH) of prescription, types of antibiotics, and patients' age group. Regional prescribing rates, choice of antibiotic, and appropriateness of prescribing were compared for otitis media, sinusitis, tonsillitis, bronchitis, cystitis, and impetigo. Appropriateness was assessed by comparing all relevant information from medical files with the guideline recommendations.RESULTS: Only 6% of GP-prescribed antibiotics were prescribed OOH. OOH, cystitis and acute otitis media presented most often. First-choice prescribing was comparable for the two settings, whereas prescribing rates were higher OOH, with comparatively more amoxicillin(/clavulanate). The appropriateness evaluation, however, revealed that overprescribing was comparable, or even lower than, for daily practice.CONCLUSION: The suggestion that OOH antibiotic prescribing quality is worse than in daily practice does not seem founded. The higher OOH prescribing rates can be explained by a different population of presenting patients. The appropriateness of prescribing rather than prescribing rates, therefore, should be used to determine quality.
AB - BACKGROUND: Unnecessary and non-first-choice antibiotic prescribing is a significant problem in primary care. It is often argued that irrational prescribing is higher during out-of-hours (OOH) consultations.AIM: To obtain insight into the quantity and quality of OOH antibiotic prescribing for commonly presented infectious diseases.DESIGN AND SETTING: Two two-way comparisons of 1) nationally dispensed antibiotics during office hours and OOH care, using data from the Dutch Foundation of Pharmaceutical Statistics, and 2) regional prescribing quality data from 45 primary care practices from Utrecht and its vicinity, and two large OOH services in Utrecht and Woerden.METHOD: From the national data, yearly dispensed antibiotics were analysed per prescriber type, with respect to time (office hours or OOH) of prescription, types of antibiotics, and patients' age group. Regional prescribing rates, choice of antibiotic, and appropriateness of prescribing were compared for otitis media, sinusitis, tonsillitis, bronchitis, cystitis, and impetigo. Appropriateness was assessed by comparing all relevant information from medical files with the guideline recommendations.RESULTS: Only 6% of GP-prescribed antibiotics were prescribed OOH. OOH, cystitis and acute otitis media presented most often. First-choice prescribing was comparable for the two settings, whereas prescribing rates were higher OOH, with comparatively more amoxicillin(/clavulanate). The appropriateness evaluation, however, revealed that overprescribing was comparable, or even lower than, for daily practice.CONCLUSION: The suggestion that OOH antibiotic prescribing quality is worse than in daily practice does not seem founded. The higher OOH prescribing rates can be explained by a different population of presenting patients. The appropriateness of prescribing rather than prescribing rates, therefore, should be used to determine quality.
KW - antibiotics
KW - drug prescribing
KW - infectious disease
KW - out-of-hours service
KW - prescribing quality
KW - primary care
U2 - 10.3399/bjgp17X689641
DO - 10.3399/bjgp17X689641
M3 - Article
C2 - 28232364
SN - 0960-1643
VL - 67
SP - e178-e186
JO - British Journal of General Practice
JF - British Journal of General Practice
IS - 656
ER -