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Miller KM, Barnett TC, Cadarette D, Bloom DE, Carapetis JR, Cannon JW. Antibiotic consumption for sore throat and the potential effect of a vaccine against group A Streptococcus: a systematic review and modelling study. EBioMedicine 2023; 98:104864. [PMID: 37950997 PMCID: PMC10663680 DOI: 10.1016/j.ebiom.2023.104864] [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: 05/11/2023] [Revised: 10/15/2023] [Accepted: 10/19/2023] [Indexed: 11/13/2023] Open
Abstract
BACKGROUND Antibiotic consumption can lead to antimicrobial resistance and microbiome imbalance. We sought to estimate global antibiotic consumption for sore throat, and the potential reduction in consumption due to effective vaccination against group A Streptococcus (Strep A). METHODS We reviewed and analysed articles published between January 2000 and February 2022, identified though Clarivate Analytics' Web of Science search platform, with reference to antibiotic prescribing or consumption, sore throat, pharyngitis, or tonsillitis. We then used those analyses, combined with assumptions for the effectiveness, duration of protection, and coverage of a vaccine, to calculate the estimated reduction in antibiotic prescribing due to the introduction of Strep A vaccines. FINDINGS We identified 101 studies covering 38 countries. The mean prescribing rate for sore throat was approximately 5 courses per 100 population per year, accounting for approximately 5% of all antibiotic consumption. Based on 2020 population estimates for countries with empiric prescribing rates, antibiotic consumption for sore throat was estimated to exceed 37 million courses annually, of which half could be attributable to treatment for Strep A. A vaccine that reduces rates of Strep A infection by 80%, with 80% coverage and 10 year's duration of protection, could avert 2.8 million courses of antibiotics prescribed for sore throat treatment among 5-14 year-olds in countries with observed prescribing rates, increasing to an estimated 7.5 million averted if an effective vaccination program also reduced precautionary prescribing. INTERPRETATION A vaccine that prevents Strep A throat infections in children may reduce antibiotic prescribing for sore throat by 32-87% depending on changes to prescribing and consumption behaviours. FUNDING The Wellcome Trust, grant agreement number 215490/Z/19/Z.
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Affiliation(s)
- Kate M Miller
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia; School of Population and Global Health, University of Western Australia, Nedlands, Western Australia, Australia
| | - Timothy C Barnett
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia; Marshall Centre for Infectious Diseases Research and Training, School of Biomedical Sciences, University of Western Australia, Nedlands, Western Australia, Australia
| | - Daniel Cadarette
- Harvard Kennedy School, Harvard University, Cambridge, MA, United States
| | - David E Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Jonathan R Carapetis
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia; Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Jeffrey W Cannon
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia; Centre for Child Health Research, Medical School, University of Western Australia, Nedlands, Western Australia, Australia.
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Hibbert P, Stephens JH, de Wet C, Williams H, Hallahan A, Wheaton GR, Dalton C, Ting HP, Arnolda G, Braithwaite J. Assessing the Quality of the Management of Tonsillitis among Australian Children: A Population-Based Sample Survey. Otolaryngol Head Neck Surg 2018; 160:137-144. [PMID: 30149777 DOI: 10.1177/0194599818796137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aims of this study were twofold: (1) to design and validate a set of clinical indicators of appropriate care for tonsillitis and (2) to measure the level of tonsillitis care that is in line with guideline recommendations in a sample of Australian children. STUDY DESIGN A set of tonsillitis care indicators was developed from available national and international guidelines and validated in 4 stages. This research used the same design as the CareTrack Kids study, which was described in detail elsewhere. SETTING Samples of patient records from general practices, emergency departments, and hospital admissions were assessed. SUBJECTS AND METHODS Patient records of children aged 0 to 15 years were assessed for the presence of, and adherence to, the indicators for care delivered in 2012 and 2013. RESULTS Eleven indicators were developed. The records of 821 children (mean age, 5.0 years; SD, 4.0) with tonsillitis were screened. The reviewers conducted 2354 eligible indicator assessments across 1127 visits. Adherence to 6 indicators could be assessed and ranged from 14.3% to 73.2% (interquartile range 31.5% to 72.2%). CONCLUSION Our main findings are consistent with the international literature: the treatment of many children who present with confirmed or suspected tonsillitis is inconsistent with current guidelines. Future research should consider how the indicators could be applied in a structured and automated manner to increase the reliability and efficiency of record reviews and help raise clinicians' awareness of appropriate tonsillitis management.
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Affiliation(s)
- Peter Hibbert
- 1 Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Australia.,2 School of Health Sciences, University of South Australia, Adelaide, Australia
| | | | - Carl de Wet
- 3 School of Medicine, Griffith University, Southport, Australia.,4 Menzies Health Institute Queensland, Nathan, Australia
| | - Helena Williams
- 5 Southern Adelaide Local Health Network, Adelaide, Australia
| | - Andrew Hallahan
- 6 Children's Health Queensland, Lady Cilento Children's Hospital, South Brisbane, Australia.,7 School of Medicine, University of Queensland, Herston, Australia
| | - Gavin R Wheaton
- 8 Department of Cardiology, Women's and Children's Hospital, North Adelaide, Australia
| | | | - Hsuen P Ting
- 1 Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Australia
| | - Gaston Arnolda
- 1 Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Australia
| | - Jeffrey Braithwaite
- 1 Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Australia
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Tyrstrup M, Beckman A, Mölstad S, Engström S, Lannering C, Melander E, Hedin K. Reduction in antibiotic prescribing for respiratory tract infections in Swedish primary care- a retrospective study of electronic patient records. BMC Infect Dis 2016; 16:709. [PMID: 27887585 PMCID: PMC5124268 DOI: 10.1186/s12879-016-2018-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 11/11/2016] [Indexed: 11/25/2022] Open
Abstract
Background Swedish studies on antibiotic use in primary care have been based on one-week registrations of infections. In order to study adherence to guidelines, analyses based on large databases that provide information on diagnosis linked prescriptions, are needed. This study describes trends in management of infections in Swedish primary care particularly with regards to antibiotic prescribing and adherence to national guidelines. Methods A descriptive study of Sweden’s largest database regarding diagnosis linked antibiotic prescription data, the Primary care Record of Infections in Sweden (PRIS), for the years 2008, 2010 and 2013. Results Although the consultation rate for all infections remained around 30% each year, antibiotic prescribing rates decreased significantly over the years from 53.7% in 2008, to 45.5% in 2010, to 38.6% in 2013 (p = .032). The antibiotic prescribing rate for respiratory tract infections (RTIs) decreased from 40.5% in 2008 to 24.9% in 2013 while those for urinary tract infections and skin and soft tissue infections were unchanged. For most RTI diagnoses there was a decrease in prescription rate from 2008 to 2013, particularly for the age group 0–6 years. Phenoxymethylpenicillin (PcV) was the antibiotic most often prescribed, followed by tetracycline. Tonsillitis and acute otitis media were the two RTI diagnoses with the highest number of prescriptions per 1000 patient years (PY). For these diagnoses an increase in adherence to national guidelines was seen, with regards to treatment frequency, choice of antibiotics and use of rapid antigen detection test. The frequency in antibiotic prescribing varied greatly between different Primary Healthcare Centres (PHCCs). Conclusion Falling numbers of consultations and decreased antibiotic prescription rates for RTIs have reduced the antibiotic use in Swedish primary care substantially. Overprescribing of antibiotics could still be suspected due to large variability in prescribing frequency, especially for acute bronchitis and sinusitis. Continuous evaluation of diagnosis linked prescribing data and feedback to doctors is essential in order to achieve a more prudent antibiotic use. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-2018-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mia Tyrstrup
- Department of Clinical Sciences, Family Medicine, Lund University, Malmö, Sweden.
| | - Anders Beckman
- Department of Clinical Sciences, Family Medicine, Lund University, Malmö, Sweden
| | - Sigvard Mölstad
- Department of Clinical Sciences, Family Medicine, Lund University, Malmö, Sweden
| | - Sven Engström
- Unit of Research and Development in Primary Care, Jönköping, Sweden
| | | | - Eva Melander
- Department of Infection Control, Malmö, Skåne County, Sweden.,Department of translational medicine, Lund University, Malmö, Sweden
| | - Katarina Hedin
- Department of Clinical Sciences, Family Medicine, Lund University, Malmö, Sweden.,Department of Research and Development, Region Kronoberg, Växjö, Sweden
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Lindström J, Nordeman L, Hagström B. What a difference a CRP makes. A prospective observational study on how point-of-care C-reactive protein testing influences antibiotic prescription for respiratory tract infections in Swedish primary health care. Scand J Prim Health Care 2015; 33:275-82. [PMID: 26643196 PMCID: PMC4750737 DOI: 10.3109/02813432.2015.1114348] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 10/02/2015] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To explore how C-reactive protein (CRP) tests serve to support physicians in decisions concerning antibiotic prescription to patients with respiratory tract infections (RTI). DESIGN Prospective observational study. SETTING Primary health care centres in western Sweden. SUBJECTS Physicians in primary health care. Patients with acute RTI. MAIN OUTCOME MEASURES Physician willingness to measure CRP, their ability to estimate CRP, and changes in decision-making concerning antibiotic treatment based on error estimate and the physician's opinion of whether CRP measurement was crucial. RESULTS Data from 340 consultations were gathered. CRP testing was found to be crucial in 130 cases. In 86% of visits decisions regarding antibiotic prescription were unchanged. Physicians considering CRP crucial and physicians making an error estimate of CRP altered their decisions concerning antibiotic prescription after CRP testing more often than those who considered CRP unnecessary, and those making a more accurate estimate. Physicians changed their decision on antibiotic prescription in 49 cases. In the majority of these 49 cases physicians underestimated CRP levels, and the majority of changes were from "no" to "yes" as to whether to prescribe antibiotics. CONCLUSION CRP is an important factor in the decision on whether to prescribe antibiotics for RTIs. Error estimates of CRP and willingness to measure CRP are important factors leading to physicians changing decisions on antibiotic treatment. Key points There is a generally low antibiotic prescription rate and a high frequency of C-reactive protein (CRP) testing for respiratory tract infections (RTIs) in Sweden. CRP testing was considered essential to further management in 38% of cases. In 86% of visits decisions concerning antibiotic prescription were unchanged. The strongest predictors for revised decisions on antibiotic treatment were error estimates of CRP and the physician's opinion that CRP measurement was crucial.
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Affiliation(s)
| | - Lena Nordeman
- Närhälsan, Research and Development Primary Health Care Region Västra Götaland, Research and Development Center Södra Älvsborg, University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Unit of Physiotherapy, Sweden
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Tell D, Engström S, Mölstad S. Adherence to guidelines on antibiotic treatment for respiratory tract infections in various categories of physicians: a retrospective cross-sectional study of data from electronic patient records. BMJ Open 2015; 5:e008096. [PMID: 26179648 PMCID: PMC4513445 DOI: 10.1136/bmjopen-2015-008096] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To study how prescription patterns concerning respiratory tract infections differ between interns, residents, younger general practitioners (GPs), older GPs and locums. DESIGN Retrospective study of structured data from electronic patient records. SETTING Data were obtained from 53 health centres and 3 out-of-hours units in Jönköping County, Sweden, through their common electronic medical record database. PARTICIPANTS All physicians working in primary care during the 2-year study period (1 November 2010 to 31 October 2012). OUTCOME MEASURES Physicians' adherence to current guidelines for respiratory tract infections regarding the use of antibiotics. RESULTS We found considerable differences in prescribing patterns between physician categories. The recommended antibiotic, phenoxymethylpenicillin, was more often prescribed by interns, residents and younger GPs, while older GPs and locums to a higher degree prescribed broad-spectrum antibiotics. The greatest differences were seen when the recommendation in guidelines was to refrain from antibiotics, as for acute bronchitis. Interns and residents most often followed guidelines, while compliance in descending order was: young GPs, older GPs and locums. We also noticed that male doctors were somewhat overall more restrictive with antibiotics than female doctors. CONCLUSIONS In general, primary care doctors followed national guidelines on choice of antibiotics when treating respiratory tract infections in children but to a lesser degree when treating adults. Refraining from antibiotics seems harder. Adherence to national guidelines could be improved, especially for acute bronchitis and pneumonia. This was especially true for older GPs and locums whose prescription patterns were distant from the prevailing guidelines.
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Affiliation(s)
- David Tell
- Råslätt Health Care Centre, Jönköping, Sweden
| | - Sven Engström
- Primary Care Research and Development Unit, Futurum, Jönköping, Sweden
| | - Sigvard Mölstad
- Department of Clinical Sciences, General Practice, Lund University, Lund, Sweden
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van de Vooren K, Duranti S, Curto A, Garattini L. Cost effectiveness of the new pneumococcal vaccines: a systematic review of European studies. PHARMACOECONOMICS 2014; 32:29-45. [PMID: 24288207 DOI: 10.1007/s40273-013-0113-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Diseases caused by Streptococcus pneumoniae (pneumococcus) are a major global public health problem. Despite their importance, information on the burden of the different pneumococcal diseases is limited and estimates vary widely. OBJECTIVE AND METHODS We critically reviewed the full economic evaluations (FEEs) on the new pneumococcal conjugate vaccines (PCVs) conducted in the European Union (EU) to assess their potential contribution to public decision making. We selected the FEEs focussed on PCV-10 and PCV-13 and published in English from January 2007 until June 2013. We screened the selected articles to assess their main methodological features using a common checklist composed of epidemiological, clinical and economic items. RESULTS All the ten studies selected were based on modelling and the time horizon was always long term. Two studies focused on adults, the remaining eight on infants. Only one study based herd immunity on national data, eight used foreign data or modelling and the last did not consider it. National prices and tariffs were claimed to be sources for unit costs in all studies; however, half of them assumed price parity when one vaccine was not yet marketed, and the figures varied within the countries where more than one study was conducted. Conclusions supported the economic utility of pneumococcal vaccination in all studies, raising some concern only in (i) the independent study, which found that PCV-13 was borderline cost effective, and (ii) the study sponsored by both manufacturers, which estimated an incremental ratio slightly above the national threshold for both PCV-10 and PCV-13. CONCLUSION The European studies we analysed are mostly based on weak sources of data. Because of the limited information on vaccine effectiveness and lack of epidemiological and economic data, the need for extensive recourse to assumptions leads to great within- and between-study variability generated by authors' choices.
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Affiliation(s)
- Katelijne van de Vooren
- CESAV, Centre for Health Economics, IRCCS Institute for Pharmacological Research 'Mario Negri', Via Camozzi, 3 c/o Villa Camozzi, Ranica, 24020, Bergamo, Italy
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Klok RM, Lindkvist RM, Ekelund M, Farkouh RA, Strutton DR. Cost-Effectiveness of a 10- Versus 13-Valent Pneumococcal Conjugate Vaccine in Denmark and Sweden. Clin Ther 2013; 35:119-34. [DOI: 10.1016/j.clinthera.2012.12.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 12/08/2012] [Accepted: 12/12/2012] [Indexed: 10/27/2022]
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By Å, Sobocki P, Forsgren A, Silfverdal SA. Comparing Health Outcomes and Costs of General Vaccination with Pneumococcal Conjugate Vaccines in Sweden: A Markov Model. Clin Ther 2012; 34:177-89. [DOI: 10.1016/j.clinthera.2011.12.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2011] [Indexed: 10/14/2022]
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Neumark T, Brudin L, Mölstad S. Use of rapid diagnostic tests and choice of antibiotics in respiratory tract infections in primary healthcare--a 6-y follow-up study. ACTA ACUST UNITED AC 2010; 42:90-6. [PMID: 19902992 DOI: 10.3109/00365540903352932] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this retrospective study of electronic patient records in primary health care in Kalmar County, Sweden, was to describe consultations for respiratory tract infections (RTIs) in relation to age, choice of antibiotics and the use of rapid diagnostic tests. During the period 1999-2005, 240,445 visits for RTI were recorded. Children aged <2 y and especially those aged 2-16 y with acute otitis media (AOM), showed decreasing consultations between 2000 and 2005. The consultations for sore throat declined during the study period in all age groups and in 65% of these, antibiotics were prescribed, primarily penicillin V (82%). In sore throat, a positive Strep-A test result was followed by antibiotic prescription in about 92% of cases; when negative, the antibiotic prescription rate was 40%. C-reactive protein (CRP) was analyzed in 36% of all consultations for RTI. In common cold and acute bronchitis, the prescription rates of antibiotics rose with rising CRP. The results show that near-patient tests were used extensively, but often not in accordance with the guidelines. Antibiotic use decreased mainly as a consequence of declined visiting frequencies. This indicates that the new guidelines for AOM and sore throat may have influenced patient consultation habits more than physician prescribing habits.
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Affiliation(s)
- Thomas Neumark
- Lindsdals Primary Health Centre, Förlösavägen 4, Kalmar, Sweden.
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Muscat M, Monnet DL, Klemmensen T, Grigoryan L, Jensen MH, Andersen M, Haaijer-Ruskamp FM. Patterns of antibiotic use in the community in Denmark. ACTA ACUST UNITED AC 2009; 38:597-603. [PMID: 16857602 DOI: 10.1080/00365540600606507] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A cross-sectional descriptive population survey was conducted in 2003 to examine epidemiological characteristics of antibiotic use in the community in Denmark and particularly in the area of self-medication with antibiotics. Self-medication with antibiotics was rare in Denmark. 97% of antibiotics used were obtained after a medical consultation. While the existing legal framework preventing over-the-counter dispensation of antibiotics must be maintained, our results show that, in Denmark, interventions to optimize antibiotic use should primarily focus on the prescribers.
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Affiliation(s)
- Mark Muscat
- National Centre of Antimicrobials and Infection Control, Statens Serum Institut, Copenhagen, Denmark
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Neumark T, Brudin L, Engstrom S, Molstad S. Trends in number of consultations and antibiotic prescriptions for respiratory tract infections between 1999 and 2005 in primary healthcare in Kalmar County, Southern Sweden. Scand J Prim Health Care 2009; 27:18-24. [PMID: 19085427 PMCID: PMC3410472 DOI: 10.1080/02813430802610784] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Indexed: 10/21/2022] Open
Abstract
UNLABELLED BACKGROUND. Respiratory tract infections (RTIs) comprise the most common indication for consulting a general practitioner and obtaining an antibiotic prescription. OBJECTIVE To study changes in the number of visits, diagnoses, and antibiotic prescriptions for RTI in primary healthcare during the period 1999-2005. DESIGN A retrospective, descriptive, population-based study of electronic patient records. Setting. County of Kalmar in southeastern Sweden. PATIENTS Patients visiting primary healthcare units in Kalmar County for an RTI between 1 July 1999 and 31 December 2005. MAIN OUTCOME MEASURES RTI diagnoses, antibiotic prescriptions, age groups. RESULTS A total of 240 447 visits for RTI made between 1999 and 2005 were analysed. The yearly consultation rates for the diagnoses acute tonsillitis and AOM decreased by 12% and 10%, respectively (p = 0.001). Of all patients consulting for an RTI diagnosis, 45% received antibiotics. Of all prescribed antibiotics, 60% were for phenoxymethylpenicillin (PcV) and 18% doxycycline. Amoxicillin or amoxicillin + clavulanic acid was prescribed to a lesser extent. The proportion of patients obtaining an antibiotic prescription was almost constant over time (44-46%). The prescriptions of doxycycline showed increasing values (NS). The prescriptions of remaining antibiotics decreased significantly especially for patients up to middle age. CONCLUSION This large population study, comprising more than six years of observations, showed the number of primary healthcare patients receiving an RTI diagnosis decreased during the period 1999-2005, but the proportion of patients receiving an antibiotic prescription remained the same. The large seasonal variations indicate a need for further interventions to decrease antibiotic use for RTIs.
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Affiliation(s)
- Thomas Neumark
- Lindsdals Primary Health Centre, Förlösavägen 4, Kalmar, Sweden.
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Gijsen R, Poos MJJC. Using registries in general practice to estimate countrywide morbidity in The Netherlands. Public Health 2006; 120:923-36. [PMID: 16949625 DOI: 10.1016/j.puhe.2006.06.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2005] [Revised: 04/20/2006] [Accepted: 06/05/2006] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Examining the possibility of using data from registries in general practice in order to present morbidity figures concerning a broad range of major diseases for the Dutch population. STUDY DESIGN Qualitative and quantitative analysis of registered diagnoses. METHODS Quantitative data from six registries were obtained. In addition, information about the registration process was obtained and discussed with representatives of the registries. Subjects for discussion were the general characteristics of the registries and disease-specific rules. RESULTS Some important differences exist in the characteristics of the registries and the disease-specific coding rules for computing incidence and prevalence. However, for most diseases the rules of two or more registries corresponded with each other, so that a selection of registries that measured the occurrence of a particular disease in a similar way could be made. Nevertheless, for some age categories rather large differences between registries were observed. The best estimates for the whole country were calculated as the average incidence and prevalence of the selected registries. CONCLUSIONS Data that were originally obtained during patient care can be made usable for public health policy purposes. To further improve the quality of data and to increase the usefulness of these data for public health policy purposes, more efforts are required.
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Affiliation(s)
- Ronald Gijsen
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
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