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Bornemann R, Heidenreich A, Hoyer A, Mohsenpour A, Tillmann R. [Analysis of factors influencing outpatient paediatric antibiotic prescriptions in Bielefeld from 2015 to 2018]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:1010-1020. [PMID: 38837054 PMCID: PMC11349860 DOI: 10.1007/s00103-024-03891-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 05/06/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND There are significant regional differences in antibiotic prescribing behaviour. The reasons for this are still largely unknown. Beneath demographic and morbidity-related factors, doctor-specific or "cultural" factors may also play a role. A differentiated analysis including diagnostic data is needed to put these data into context. METHODS A data analysis with secondary data available via the Westphalia-Lippe Association of Statutory Health Insurance Physicians (KVWL) was conducted on infection diagnoses and antibiotic prescriptions of outpatient paediatricians in the KV district of Bielefeld from 2015 to 2018. In addition, algorithmized 1:1 connections between diagnoses and prescriptions were performed. RESULTS For 262,969 "medication patients" (AMP), 28,248 antibiotic prescriptions and 90,044 infection diagnoses were evaluated, from which 11,131 1:1 connections could be generated. Concerning the prescribing behaviour of individual paediatric GP offices, after adjusting for the denominator AMP and despite a comparable age and gender structure, there were some significant differences. This affected both the frequency of prescriptions and the qualitative composition of the substance groups prescribed. DISCUSSION The differences in antibiotic prescribing behaviour, even at GP office level, cannot be adequately explained by the demographic composition or different morbidities of the respective clientele. Individual attitudes and local prescribing cultures are likely to play a relevant role. To address these offers an important approach for antibiotic stewardship (ABS). In addition to the area of outpatient paediatrics presented here, the methodology described can also be used as a model for more detailed analysis in other outpatient speciality groups.
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Affiliation(s)
- Reinhard Bornemann
- AG 2 Bevölkerungsmedizin und Versorgungsforschung, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Universitätsstraße 25, 33615, Bielefeld, Deutschland.
| | - Andreas Heidenreich
- Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck, Lübeck, Deutschland
| | - Annika Hoyer
- Biostatistik und Medizinische Biometrie, Medizinische Fakultät OWL, Universität Bielefeld, Bielefeld, Deutschland
| | - Amir Mohsenpour
- AG 2 Bevölkerungsmedizin und Versorgungsforschung, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Deutschland
| | - Roland Tillmann
- Praxis für Kinder- und Jugendmedizin Roland Tillmann, Bielefeld, Deutschland
- Ärztenetz Bielefeld, Bielefeld, Deutschland
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Leitzen S, Dubrall D, Toni I, Stingl J, Christ P, Köberle U, Schmid M, Neubert A, Sachs B. Adverse Drug Reactions in Children: Comparison of Reports Collected in a Pharmacovigilance Project Versus Spontaneously Collected ADR Reports. Paediatr Drugs 2023; 25:203-215. [PMID: 36369590 PMCID: PMC9931796 DOI: 10.1007/s40272-022-00540-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Adverse drug reactions (ADRs) and medication errors in children may result from a lack of appropriate drugs, dosages, and pharmaceutical forms. In addition, children may respond differently to drugs than adults. Reporting of ADRs in the pediatric population is therefore of importance in order to increase the amount of safety data. However, different methodological approaches are used to collect ADRs. OBJECTIVE The aim of the present study was to analyze whether there were differences in the ADRs collected in the KiDSafe project (845 ADR reports) compared with the spontaneous ADR reports sent to EudraVigilance (697 reports) in the same time period. The strengths and limitations of these two different approaches should be discussed. METHODS The same inclusion criteria were applied for the systematically collected ADRs in the KiDSafe project and the spontaneous reports from EudraVigilance, and only reports of ADRs coded with hospitalization were considered. In both datasets, the number of reports (related to number of hospitals), their documentation quality (VigiGrade), causal relationship (World Health Organization-Uppsala Monitoring Centre [WHO-UMC] criteria), most frequently reported drugs and ADRs, demographical parameters of the patients, reported medical histories, and the seriousness of ADR reports were analyzed descriptively. The results of the two analyses were compared. RESULTS There was considerable underreporting of ADRs via the spontaneous reports (0.4 reports per hospital; 697/1902) compared with 70.4 reports per hospital (845/12) in the systematically collected KiDSafe reports. Documentation quality assessment yielded similar results in both datasets. Among the 10 most frequently reported drugs, anticonvulsants such as levetiracetam (6.6%), valproic acid (5.6%), oxcarbazepine (3.6%), and lamotrigine (3.4%) were mainly reported in the KiDSafe reports, while in the EudraVigilance reports, mite allergen extract (4.4%) and allergens (3.6%) were preferentially reported. Seizures were the most frequently reported clinically specific ADRs in the KiDSafe reports, whereas anaphylactic reactions and urticaria were prominent in the spontaneous reports from EudraVigilance. Notably, the proportion of reports referring to medication errors and other medication safety related issues were more prominent in KiDSafe than in the spontaneous reports (27.8% vs. 12.6% and 46.0% vs. 29.0%, respectively). CONCLUSION In general, reports from both data sources contributed to the identification of ADRs and dedicated issues related to drug therapy. However, these differed by nature and strength of the signal, likely due to the characteristics of the individual method. A combined approach could likely compensate for limitations inherent to the single approaches, but will most likely only be applied to dedicated pharmacovigilance topics or research objectives.
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Affiliation(s)
- Sarah Leitzen
- Research Division, Federal Institute for Drugs and Medical Devices, Bonn, Germany ,Department of Physics, Chemistry and Pharmacy, University of Southern Denmark, Odense, Denmark ,Institute for Medical Biometry, Informatics and Epidemiology, University Hospital of Bonn, Bonn, Germany
| | - Diana Dubrall
- Research Division, Federal Institute for Drugs and Medical Devices, Bonn, Germany. .,Institute for Medical Biometry, Informatics and Epidemiology, University Hospital of Bonn, Bonn, Germany.
| | - Irmgard Toni
- Department of Paediatrics and Adolescent Medicine, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Julia Stingl
- Institute of Clinical Pharmacology, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Patrick Christ
- Research Division, Federal Institute for Drugs and Medical Devices, Bonn, Germany ,Institute for Medical Biometry, Informatics and Epidemiology, University Hospital of Bonn, Bonn, Germany
| | - Ursula Köberle
- Drug Commission of the German Medical Association, Berlin, Germany
| | - Matthias Schmid
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital of Bonn, Bonn, Germany
| | - Antje Neubert
- Department of Paediatrics and Adolescent Medicine, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Bernhardt Sachs
- Research Division, Federal Institute for Drugs and Medical Devices, Bonn, Germany ,Department for Dermatology and Allergy, University Hospital Aachen, Aachen, Germany
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Regional Variations in Outpatient Antibiotic Prescribing in Germany: A Small Area Analysis Based on Claims Data. Antibiotics (Basel) 2022; 11:antibiotics11070836. [PMID: 35884090 PMCID: PMC9312140 DOI: 10.3390/antibiotics11070836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/19/2022] [Accepted: 06/20/2022] [Indexed: 11/18/2022] Open
Abstract
A comprehensive small area description of regional variations in outpatient antibiotic prescribing in Germany is lacking. Using the German Pharmacoepidemiological Research Database (GePaRD), a claims database covering ~20% of the German population, we determined the age- and sex-standardized prescription rates of antibiotics (number of outpatient prescriptions per 1000 persons/year). We calculated these prescription rates overall and on the level of 401 German districts for the calendar years 2010 and 2018. In 2018, the standardized prescription rate of antibiotics in the total study population was 23% lower than in 2010 (442 vs. 575 per 1000 persons/year). Among 0–17-year-olds, prescription rates across districts ranged from 312 to 1205 in 2010 and from 188 to 710 in 2018 per 1000 persons/year; among adults (≥18 years), they ranged from 388 to 841 in 2010 and from 300 to 693 in 2018 per 1000 persons/year. Despite the overall decline in outpatient antibiotic prescribing between 2010 and 2018, regional variations at the district level remained high in all age groups in Germany. Identifying reasons that explain the persistently high prescription rates in certain regions will be helpful in designing effective and tailored measures to further improve antibiotic stewardship in these regions.
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