Silvia Hernández

Universitat Rovira i Virgili, Tarraco, Catalonia, Spain

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Publications (35)66.84 Total impact

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    ABSTRACT: General practitioners (GPs) often feel uncomfortable when patients request an antibiotic when there is likely little benefit. This study evaluates the effect of access to point-of-care tests on decreasing the prescription of antibiotics in respiratory tract infections in subjects who explicitly requested an antibiotic prescription. Spanish GPs registered all cases of respiratory tract infections over a 3-week period before and after an intervention undertaken in 2008 and 2009. Patients with acute sinusitis, pneumonia, and exacerbations of COPD were excluded. Two types of interventions were performed: the full intervention group received prescriber feedback with discussion of the results of the first registry, courses for GPs, guidelines, patient information leaflets, workshops, and access to point-of-care tests (rapid streptococcal antigen detection test and C-reactive protein test); and the partial intervention group underwent all of the above interventions except for the workshop and access to point-of-care tests. A total of 210 GPs were assigned to the full intervention group and 71 to the partial intervention group. A total of 25,479 subjects with respiratory tract infections were included, of whom 344 (1.4%) requested antibiotic prescribing. Antibiotics were more frequently prescribed to subjects requesting them compared with those who did not (49.1% vs 18.5%, P < .001). In the group of GPs assigned to the partial intervention group, 53.1% of subjects requesting antibiotics received a prescription before and 60% after the intervention, without statistical differences being observed. In the group of GPs assigned to the full intervention group, the percentages were 55.1% and 36.2%, respectively, with a difference of 18.9% (95% CI: 6.4%-30.6%, P < .05). Access to point-of-care tests reduces antibiotic use in subjects who explicitly request an antibiotic prescription. Copyright © 2014 by Daedalus Enterprises.
    Respiratory care. 12/2014; 59(12):1918-23.
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    ABSTRACT: To evaluate the effectiveness of two types of intervention in reducing antibiotic prescribing in respiratory tract infections (RTI). Before-after audit-based study. Primary Care centres in Spain. General practitioners (GPs) registered all patients with RTIs for 15 days in winter 2008 (pre-intervention), and again in winter 2009 (post-intervention). Intervention activities included meetings, with the presentation and discussion of the results, and several training meetings on RTI guidelines, information brochures for patients, workshops on point-of-care tests - rapid antigen detection tests and C-reactive protein rapid test - and provision of these tests in the clinic. All GPs, with the exception of those in Catalonia, made up the full intervention group (FIG); conversely, Catalan doctors underwent the same intervention, except for the workshop on rapid tests (partial intervention group, PIG). Multilevel logistic regression was performed taking the prescription of antibiotics as the dependent variable. Out of a total of 309 GPs involved in the first register, 281 completed the intervention and the second register (90.9%), of which 210 were assigned to the FIG, and 71 to the PIG. The odds ratio of antibiotic prescribing after the intervention was 0.99 (95% CI: 0.89-1.10) among GPs assigned to PIG, and 0.50 (95% CI: 0.44-0.57, p<0.001) among those who were allocated to FIG. The reduction in antibiotic prescribing in FIG was more marked in flu infection, common cold, acute pharyngitis, acute tonsillitis, and acute bronchitis. Active participation of GPs with the performance of point-of-care tests in the clinic is accompanied by a drastic reduction of antibiotic use in RTIs, primarily in infections considered as mainly viral.
    Atención Primaria 04/2014; · 0.96 Impact Factor
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    ABSTRACT: Objetivo Evaluar la efectividad de dos tipos de intervención en la prescripción antibiótica en infecciones del tracto respiratorio (ITR). Diseño Estudio antes-después basado en audit. Emplazamiento Centros de atención primaria de España. Participantes Médicos de familia registraron durante 15 días en invierno 2008 todas las ITR (preintervención), que se repitió en 2009 (postintervención). Intervenciones Se realizaron reuniones con presentación y discusión de resultados, sesiones de formación en guías de ITR, folletos informativos para pacientes, talleres en uso de pruebas rápidas (Strep A y proteína C reactiva) y su provisión en las consultas. Los médicos participantes a excepción de Cataluña realizaron la intervención completa (IC), mientras que los médicos de Cataluña realizaron lo mismo menos el taller de pruebas rápidas (intervención parcial [IP]). Se efectuó análisis de regresión logística multinivel considerando como variable dependiente la prescripción antibiótica. Resultados De los 309 médicos que realizaron el primer registro, 281 completaron la intervención y el segundo registro (90,9%), de los cuales 210 se asignaron a IC y 71 a IP. La odds ratio de prescripción antibiótica después de la intervención fue de 0.99 (IC95%: 0,89–1,10) entre los médicos asignados a IP, mientras que el observado en la IC fue de 0.50 (IC95%: 0,44–0,57, p < 0,001). La mayor reducción de prescripción antibiótica en IC se observó en gripe, catarro común, faringitis aguda, amigdalitis aguda y bronquitis aguda. Conclusiones La participación activa de los médicos con uso de pruebas rápidas en la consulta se acompaña de una reducción importante de antibióticos en las ITR, sobre todo en las infecciones mayoritariamente virales.
    Atención Primaria. 01/2014;
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    ABSTRACT: Anthonisen's criteria are widely used to guide the need for antibiotics in exacerbations of chronic obstructive pulmonary disease (COPD). We evaluated the best predictors of outcomes in exacerbations of mild to moderate COPD not treated with antibiotics. We used data from 152 patients of the placebo arm of a randomised trial of amoxicillin/clavulanate for exacerbations of mild to moderate COPD. Clinical response in relation to Anthonisen's criteria and point-of-test serum C-reactive protein (CRP) levels (cut off 40 mg/L) was assessed with multivariate logistic regression analysis. Clinical failure without antibiotics was 19.9% compared to 9.5% with amoxicillin/clavulanate (p=0.022). The only factors significantly associated with an increased risk of failure without antibiotics were the increase in purulence of sputum (OR=6.1, 95% confidence interval: 1.5 to 25.0; p=0.005) and a CRP concentration ≥40 mg/L (OR=13.4, 95%CI: 4.6 to 38.8; p<0.001). When both factors were present, the probability of failure without antibiotics was 63.7%. The Anthonisen criteria showed an area under the curve (AUC) of 0.708 (95% CI: 0.616 - 0.801) for predicting clinical outcome. With the addition of CRP, the AUC rose significantly to 0.842 (95% CI: 0.76 - 0.924); p<0.001. Among the Anthonisen criteria, only an increase in sputum purulence is a significant predictor of failure without antibiotics. The use of a point-of-test CRP significantly increases the predictive accuracy of failure. Both of these easy to obtain factors may help clinicians to identify exacerbated mild to moderate COPD patients that can be safely treated without antibiotics in an ambulatory setting. clinicaltrials.gov; No.: NCT00495586.
    Chest 06/2013; · 7.13 Impact Factor
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    ABSTRACT: BACKGROUND: Streptococcus pneumoniae is the bacterial agent which most frequently causes pneumonia. In some Scandinavian countries, this infection is treated with penicillin V since the resistances of pneumococci to this antibiotic are low. Four reasons justify the undertaking of this study; firstly, the cut-off points which determine whether a pneumococcus is susceptible or resistant to penicillin have changed in 2008 and according to some studies published recently the pneumococcal resistances to penicillin in Spain have fallen drastically, with only 0.9% of the strains being resistant to oral penicillin (minimum inhibitory concentration>2 µg/ml); secondly, there is no correlation between pneumococcal infection by a strain resistant to penicillin and therapeutic failure in pneumonia; thirdly, the use of narrow-spectrum antibiotics is urgently needed because of the dearth of new antimicrobials and the link observed between consumption of broad-spectrum antibiotics and emergence and spread of antibacterial resistance; and fourthly, no clinical study comparing amoxicillin and penicillin V in pneumonia in adults has been published. Our aim is to determine whether high-dose penicillin V is as effective as high-dose amoxicillin for the treatment of uncomplicated community-acquired pneumonia. METHODS: We will perform a parallel group, randomised, double-blind, trial in primary healthcare centres in Spain. Patients aged 18 to 65 without significant associated comorbidity attending the physician with signs and symptoms of lower respiratory tract infection and radiological confirmation of the diagnosis of pneumonia will be randomly assigned to either penicillin V 1.6 million units thrice-daily during 10 days or amoxicillin 1,000 mg thrice-daily during 10 days. The main outcome will be clinical cure at 14 days, defined as absence of fever, resolution or improvement of cough, improvement of general wellbeing and resolution or reduction of crackles indicating that no other antimicrobial treatment will be necessary. Any clinical result other than the anterior will be considered as treatment failure. A total of 210 patients will be recruited to detect a non-inferiority margin of 15% between the two treatments with a minimum power of 80% considering an alpha error of 2.5% for a unilateral hypothesis and maximum possible losses of 15%. DISCUSSION: This pragmatic trial addresses the long-standing hypothesis that the administration of high doses of a narrow-spectrum antibiotic (penicillin V) in patients with non-severe pneumonia attended in the community is not less effective than high doses of amoxicillin (treatment currently recommended) in patients under the age of 65 years.Trial registration: EudraCT number 2012-003511-63.
    BMC Family Practice 04/2013; 14(1):50. · 1.61 Impact Factor
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    ABSTRACT: Objective. This study was aimed at evaluating the effect of two levels of intervention on the antibiotic prescribing in patients with common cold. Methods. Before and after audit-based study carried out in primary healthcare centres in Spain. General practitioners registered all the episodes of common cold during 15 working days in January and February in 2008 (preintervention). Two types of intervention were considered: full intervention, consisting in individual feedback based on results from the first registry, courses in rational antibiotic prescribing, guidelines, patient information leaflets, workshops on rapid tests -rapid antigen detection and C-reactive protein tests- and provision of these tests in the surgeries; and partial intervention, consisting of all the above intervention except for the workshop and they did not have access to rapid tests. The same registry was repeated in 2009 (postintervention). In addition, new physicians filled out only the registry in 2009 (control group). Results. 210 physicians underwent the full intervention, 71 the partial intervention and 59 were assigned to the control group. The 340 doctors prescribed antibiotics in 274 episodes of a total of 12,373 cases registered (2.2%).The greatest percentage of antibiotic prescription was found in the control group (4.6%). The partial intervention increased the antibiotic prescription percentage from 1.1% to 2.7% while only doctors who underwent the complete intervention lead to a significant reduction of antibiotics prescribed, from 2.9% before to 0.7% after the intervention (p<0.001). Conclusion. Only physicians with access to rapid tests significantly reduced antibiotic prescription in patients with common cold.
    Revista espanola de quimioterapia: publicacion oficial de la Sociedad Espanola de Quimioterapia 03/2013; 26(1):12-20. · 0.84 Impact Factor
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    ABSTRACT: OBJECTIVES: To assess the different types of antibiotic-taking behavior and to compare self-reported with objectively measured adherence to antibiotic regimens in respiratory infections. METHODS: This was a prospective study of patients with suspected bacterial pharyngitis and lower respiratory tract infections recruited from five primary care clinics in Catalonia. Adherence to various antibiotic regimens was assessed by the Medication Event Monitoring System (MEMS), which recorded every opening of the patient's bottle of tablets, and a self-reported adherence question. The outcome variables were antibiotic-taking adherence, correct dosing, and timing adherence. RESULTS: A total of 428 patients were included in the analysis. Five types of antibiotic use behavior were observed: excellent adherence (130 patients, 30.4%), acceptable adherence over time (53; 12.4%), declining adherence over time (123; 28.7%), non-adherence to correct dosing (108; 25.2%), and unacceptable adherence (14; 3.3%). Excellent adherence was significantly associated with the number of daily doses of antibiotic and antibiotic duration. A total of 254 patients reported never forgetting to take the antibiotic (59.3%), achieving a negative predictive value of 100% and a positive predictive value of 51.2%. CONCLUSIONS: Outpatients with respiratory infections treated with antibiotics showed poor adherence outcomes. Self-reported adherence was remarkably higher than that observed with the use of MEMS and failed to predict true patient adherence.
    International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases 10/2012; · 2.17 Impact Factor
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    ABSTRACT: Rationale: Antimicrobial therapy remains a controversial issue in nonsevere exacerbations of chronic obstructive pulmonary disease (COPD). Objectives: To evaluate the efficacy of antibiotic therapy in moderate exacerbations of mild-to-moderate COPD. Methods: This study involved a multicenter, parallel, double-blind, placebo-controlled, randomized clinical trial. Patients aged 40 years or older, smokers, or ex-smokers of 10 pack-years or more with spirometrically confirmed mild-to-moderate COPD (FEV(1) > 50% predicted and FEV(1)/FVC ratio < 0.7) and diagnosed with an exacerbation were enrolled in the study. The patients were randomized to receive amoxicillin/clavulanate 500/125 mg three times a day or placebo three times a day for 8 days. Measurements and Main Results: The primary outcome measure was clinical cure at end of therapy visit (EOT) at Days 9 to 11. A total of 310 subjects fulfilled all the criteria for efficacy analysis. A total of 117 patients with amoxicillin/clavulanate (74.1%) and 91 with placebo (59.9%) were considered cured at EOT (difference, 14.2%; 95% confidence interval, 3.7-24.3). The median time to the next exacerbation was significantly longer in patients receiving antibiotic compared with placebo (233 d [interquartile range, 110-365] compared with 160 d [interquartile range, 66-365]; P < 0.05). The best C-reactive protein serum cut-off for predicting clinical failure with placebo was 40 mg/L, with an area under the curve of 0.732 (95% confidence interval, 0.614-0.851). Conclusions: Treatment of ambulatory exacerbations of mild-to-moderate COPD with amoxicillin/clavulanate is more effective and significantly prolongs the time to the next exacerbation compared with placebo. Clinical trial registered with www.clinical.gov (NCT00495586).
    American Journal of Respiratory and Critical Care Medicine 08/2012; 186(8):716-23. · 11.04 Impact Factor
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    ABSTRACT: OBJECTIVE: To evaluate the effect of C-reactive protein (CRP) testing on the antibiotic prescribing in patients with acute rhinosinusitis. METHODS: Audit-based study carried out in primary care centres in Spain. GPs registered episodes of rhinosinusitis during 3-week period before and after an intervention. Two types of intervention were considered: full intervention group (FIG) consisting in individual feedback based on results from the first registry, courses in rational antibiotic prescribing, guidelines, patient information leaflets, workshops on rapid tests and use of the CRP test. GPs in the partial intervention group (PIG) underwent all the above intervention except for the workshop and they did not have access to CRP. Multilevel logistic regression analysis was performed considering the prescription of antibiotics as the dependent variable. RESULTS: Two hundred and ten physicians were assigned to FIG and 71 to PIG. In 2009, 59 new physicians were included as a control group. Two hundred and sixty-seven GPs visited contacts with rhinosinusitis (78.5%) registering a total of 836 cases. In the group of GPs with access to CRP rapid test, 207 patients with rhinosinusitis (75.3%) were tested and antibiotics were prescribed in 156 patients (56.7%). Antibiotics were prescribed in 87 patients (82.9%) in the group of GPs exposed to PIG and in 52 patients (86.7%) in the control group (P < 0.001). Antibiotic prescription was significantly reduced after the intervention among physicians assigned to FIG, with an odds ratio of antibiotic prescribing of 0.12 (95% confidence interval: 0.01-0.32). CONCLUSION: Physicians with access to CRP tests significantly reduced antibiotic prescription in patients with rhinosinusitis.
    Family Practice 03/2012; · 1.83 Impact Factor
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    ABSTRACT: Few studies have analysed adherence with antibiotic treatment in patients with respiratory tract infections. The aim of this study was to compare the compliance of patients taking a pharmacokinetically enhanced formulation of amoxicillin/clavulanic acid twice daily with that of patients taking the standard formulation thrice daily. Patients with suspected bacterial lower respiratory tract infections, pharyngitis and dental infections were included. Adherence was assessed by electronic monitoring, which recorded every opening of the patient's bottle of pills. The outcome variables were compliance with taking the medication, taking the correct dose and with timing of the dose. A total of 240 patients were enrolled (167 in the thrice-daily group and 73 in the twice-daily group). The percentage of doses taken was greater with the twice-daily regimen (84.5 ± 22.8%) than with the thrice-daily regimen (72.7 ± 20.1%; P < 0.001). Forty patients in the twice-daily group opened the container every 12 ± 6 h during at least 80% of the course (54.8%), while only 19.6% of the patients assigned to the thrice-daily formulation did so every 8 ± 4 h (P < 0.001). The percentage of patients who opened the container a satisfactory number of times per day was significantly higher among those taking the twice-daily regimen on days three, four, five, six and seven. Moreover, the thrice-daily group more frequently forgot to take the afternoon dose. The rate of compliance with amoxicillin/clavulanic acid therapy was very low. However, compliance with the new formulation that is taken twice-daily was significantly better.
    Respirology 03/2012; 17(4):687-92. · 2.78 Impact Factor
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    ABSTRACT: To evaluate the validity of a point-of-care test to diagnose infectious mononucleosis (IM) compared with Epstein-Barr virus (EBV) specific serology. Patients over 14 years with sore throat and four Centor criteria--tonsillar exudate, fever, lymph glands tenderness and absence of cough--and negative pharyngeal testing for group A β-haemolytic streptococcal antigen were consecutively recruited. All patients underwent pharyngotonsillar swab for microbiological culture, the rapid OSOM MonoTest for the diagnosis of IM in whole blood, the Paul-Bunnell test and complete blood analysis with serology for EBV and cytomegalovirus the day after the visit and at 15 days. Sensitivity and specificity were determined. We included 145 patients with a mean age of 24 ± 6.8 years. Of these, serology was determined in 129 subjects, with IM being diagnosed in 14 (10.9%). Both the MonoTest and the Paul-Bunnell test were positive in 13 patients with IM (92.9%) with no patient without disease being positive for either test--sensitivity of 92.9% (95% CI: 64.2-99.6%) and specificity of 100% (95% CI: 96-100%). The culture showed streptococcus A infection in 1 case (0.7%) and streptococcus C in 62 cases (42.8%). A total of 78 patients presented past infection by EBV (60.5%). Only one out of 10 patients with sore throat, four Centor criteria and negative rapid test for streptococcal infection presents IM. Despite the MonoTest presenting optimum sensitivity and specificity, it was found to have the same validity as the Paul-Bunnell test, with serological study continuing to be necessary for precise diagnosis of IM.
    The European journal of general practice 03/2012; 18(1):15-21.
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    ABSTRACT: This before-after study aimed to evaluate the effect of two interventions on lowering the prescription of antibiotics in lower respiratory tract infections (LRTI) in Spain. General practitioners (GPs) registered all cases with LRTIs over 3-week periods before and after an intervention, in 2008 and 2009. Two types of intervention were considered: full-intervention group (FIG), consisting of discussion sessions of the results of the first registry, courses for GPs, guidelines, patient information leaflets, workshops on rapid tests and use of the C-reactive protein (CRP) test; GPs in the partial-intervention group (PIG) underwent all of the above interventions except for the workshop on rapid tests, and they did not have access to CRP. A multilevel logistic regression analysis was performed considering the prescription of an antibiotic as the dependent variable. 210 physicians were assigned to FIG and 70 to PIG. In 2009, 58 new physicians were included as a control group. 5,385 LRTIs were registered. Compared with the control group, the OR of antibiotic prescription after the intervention in the PIG was 0.42 (95% CI: 0.22-0.82) and 0.22 (95% CI: 0.12-0.38) in the FIG. Intervention led to a reduction in the prescription of antibiotics, mainly when CRP testing was available.
    European Respiratory Journal 12/2011; 40(2):436-41. · 6.36 Impact Factor
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    ABSTRACT: Excessive use of antibiotics is worldwide the most important reason for development of antimicrobial resistance. As antibiotic resistance may spread across borders, high prevalence countries may serve as a source of bacterial resistance for countries with a low prevalence. Therefore, bacterial resistance is an important issue with a potential serious impact on all countries. Initiatives have been taken to improve the quality of antibiotic prescribing in primary care, but only few studies have been designed to determine the effectiveness of multifaceted strategies across countries with different practice setting. The aim of this study was to evaluate the impact of a multifaceted intervention targeting general practitioners (GPs) and patients in six countries with different health organization and different prevalence of antibiotic resistance. GPs from two Nordic countries, two Baltic Countries and two Hispano-American countries registered patients with respiratory tract infections (RTIs) in 2008 and 2009. After first registration they received individual prescriber feedback and they were offered an intervention programme that included training courses, clinical guidelines, posters for waiting rooms, patient brochures and access to point of care tests (Strep A and C-Reactive Protein). Antibiotic prescribing rates were compared before and after the intervention. A total of 440 GPs registered 47011 consultations; 24436 before the intervention (2008) and 22575 after the intervention (2009). After the intervention, the GPs significantly reduced the percentage of consultations resulting in an antibiotic prescription. In patients with lower RTI the GPs in Lithuania reduced the prescribing rate by 42%, in Russia by 25%, in Spain by 25%, and in Argentina by 9%. In patients with upper RTIs, the corresponding reductions in the antibiotic prescribing rates were in Lithania 20%, in Russia 15%, in Spain 9%, and in Argentina 5%. A multifaceted intervention programme targeting GPs and patients and focusing on improving diagnostic procedures in patients with RTIs may lead to a marked reduction in antibiotic prescribing. The pragmatic before-after design used may suffer from some limitations and the reduction in antibiotic prescribing could be influenced by factors not related to the intervention.
    BMC Family Practice 06/2011; 12:52. · 1.61 Impact Factor
  • Carles Llor, Ana Moragas, Silvia Hernández
    World Pumps 01/2011; 18(8):513-524.
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    ABSTRACT: to evaluate the effect of two interventions on reducing antibiotic prescription in pharyngitis. a prospective, non-randomized, before-after controlled study was carried out in primary care centres throughout Spain. General practitioners (GPs) registered all cases of pharyngitis during a 3 week period before and after two types of intervention in 2008 and 2009, respectively. Full intervention consisted of discussion sessions of the results of the first registry, courses for GPs, guidelines, patient information leaflets, workshops on rapid tests and the use of rapid antigen detection tests (RADTs) in their consulting offices. The physicians in the partial intervention group underwent all the above intervention except for the workshop, and RADTs were not provided. A control group was also included in 2009. Multilevel logistic regression was performed considering the prescription of antibiotics as the dependent variable. a total of 280 GPs registered cases with pharyngitis (70 partial intervention and 210 full intervention). Fifty-nine new physicians were included as a control group. A total of 6849 episodes of pharyngitis were registered. Antibiotic prescription was significantly lower after intervention for the full intervention group, but not for the partial intervention group. According to the multivariate model, in comparison with the control group, the odds ratio of antibiotic prescription after the intervention was 0.52 [95% confidence interval (95% CI) 0.23-1.18] in the partial intervention group and 0.23 (95% CI 0.11-0.47) in the full intervention group. intervention was beneficial for reducing the prescription of antibiotics, but was only statistically significant when the GPs were provided with RADTs.
    Journal of Antimicrobial Chemotherapy 11/2010; 66(1):210-5. · 5.34 Impact Factor
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    ABSTRACT: Background: Antibiotic resistance is global health problem for all countries leading to additional health care cost. Irrational use of antibiotics is the most important reason for development of bacterial resistance to antibiotics. Infections don't stop at the borders; bacterial resistance to antibiotics may spread across borders. Aims: To examine the antibiotic prescribing rate for patients with respiratory tract infection (RTIs) in general practice before and after intervention activities targeted professional and patients, including introduction of point of care tests: Strep A antigen test and C-reactive protein test (CRP) for the rational antibiotics prescribing in general practice and the decrease of bacterial resistance to antibiotics. Materials and methods: HAPPY AUDIT is an EU-financed project with the aim of contributing to the fight against antibiotic resistance through quality improvement of general practitioners’ diagnosis and treatment of respiratory tract infections. General practitioners (GPs) in 6 countries (n=618) registered all consultation of patients (n=33273) with respiratory tract infections (RTIs) during a 3-week period, in winter or summer (Argentina) 2008 with using a special chart of APO method of audit before the intervention to improve the antibiotic use in general practice. In winter 2009 GPs in 6 countries (n=511) once more registered all consultation of patients (n=26262) with RTIs during a 3-week period after intervention activities targeted professional and patients, including implementation of point of care (POC) tests: Strep A antigen test and C-reactive protein test (CRP )in the GPs’ surgeries. Results: The rate of antibiotic prescribing decrease of 10% after the intervention to improve the antibiotic use in general practice (from about 40% before to about 30% after).The within-practice correlation coefficient is 0.1. In countries where the POC test was been first implemented the results were higher. In Argentina a relative reduction of the total antibiotic prescribing of more than 20% has taken place. In Lithuania the antibiotic prescribing has been nearly halved. In Kaliningrad the prescribing of antibiotics has more than halved. In Spain the doctors’ prescribing of antibiotics has been reduced by one third. Conclusion: The use of APO method of audit and implementing the POC test in general practice may lead to a reduction in antibiotic prescribing to patients with RTIs and may lead to decrease of bacterial resistance to antibiotics.
    Российский семейный врач. 06/2010; 2:27.
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    ABSTRACT: Background: Antibiotic resistance is global health problem for all countries leading to additional health care cost. Irrational use of antibiotics is the most important reason for development of bacterial resistance to antibiotics. Infections don’t stop at the borders; bacterial resistance to antibiotics may spread across borders. Aims: To examine the antibiotic prescribing rate for patients with respiratory tract infection (RTIs) in general practice before and after intervention activities targeted professional and patients, including introduction of point of care tests: Strep A antigen test and C reactive protein test (CRP) for the rational antibiotics prescribing in general practice and the decrease of bacterial resistance to antibiotics. Materials and methods: HAPPY AUDIT is an EU financed project with the aim of contributing to the fight against antibiotic resistance through quality improvement of general practitioners’ diagnosis and treatment of respiratory tract infections. General practitioners (GPs) in 6 countries (n=618) registered all consultation of patients (n = 33 273) with respiratory tract infections (RTIs) during a 3_week period, in winter or summer (Argentina) 2008 with using a special chart of APO method of audit before the intervention to improve the antibiotic use in general practice. In winter 2009 GPs in 6 countries (n = 511) once more registered all consultation of patients (n = 26 262) with RTIs during a 3_week period after intervention activities targeted professional and patients, including implementation of point of care (POC) tests: Strep A antigen test and C reactive protein test (CRP )in the GPs’ surgeries. Results: The rate of antibiotic prescribing decrease of 10% after the intervention to improve the antibiotic use in general practice (from about 40% before to about 30% after).The within practice correlation coefficient is 0,1. In countries where the POC test was been first implemented the results were higher. In Argentina a relative reduction of the total antibiotic prescribing of more than 20% has taken place. In Lithuania the antibiotic prescribing has been nearly halved. In Kaliningrad the prescribing of antibiotics has more than halved. In Spain the doctors’ prescribing of antibiotics has been reduced by one third. Conclusion: The use of APO method of audit and implementing the POC test in general practice may lead to a reduction in antibiotic prescribing to patients with RTIs and may lead to decrease of bacterial resistance to antibiotics.
    РОССИЙСКИЙ СЕМЕЙНЫЙ ВРАЧ. 06/2010; 14(2-2):27.
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    ABSTRACT: Few studies have analysed adherence to antibiotic treatment in respiratory tract infections. To evaluate the impact of C-reactive protein (CRP) testing on treatment adherence among patients aged 18 or over with lower respiratory tract infection (LRTI) treated with thrice-daily antibiotic regimens. Prospective study 2003 - 2008. Office-based physician practices. We compared patient adherence prior to the use of CRP testing (no CRP test was available prior to 2007) with adherence following CRP rapid testing for suspected bacterial infection in LRTIs. Patient adherence was assessed by electronic monitoring. 161 patients with LRTI were recruited. The percentage of container openings was 76.8 ± 17.4%. Adherence was significantly better when the CRP test was performed (83.3% vs. 74.4%; p < 0.01), as was 'good timing' adherence during at least 80% of the antibiotic course (32.6% vs. 16.9%; p < 0.05). Greater antibiotic treatment adherence is observed among patients with LRTI after CRP testing at the consultation prior to administration of antibiotic treatment.
    Primary care respiratory journal: journal of the General Practice Airways Group 05/2010; 19(4):358-62.
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    ABSTRACT: Few studies have analysed adherence to antibiotic treatment in pharyngitis. The aim of this study was to evaluate the association of rapid antigen detection tests (RADT) and treatment adherence among patients 18 years of age or over with pharyngitis treated with different antibiotic regimens. Prospective study from 2003 to 2008. Office-based physician practices. Intervention. The adherence of patients prior to the use of RADTs - no test was available until mid-2006 - was compared with the adherence associated with the use of RADTs. Patients with suspected streptococcal pharyngitis. Patient adherence was assessed by electronic monitoring. The adherence outcomes considered were antibiotic-taking adherence, correct dosing, and good timing adherence during at least 80% of the antibiotic course. A total of 196 patients were recruited. The percentage of container openings was 77.9%+/-17.7%, being significantly higher for patients in whom the RADTs were performed compared with those in whom this test was not undertaken (80.1% vs. 70.8% for thrice-daily antibiotic regimens and 88.1% vs. 76.5% for twice-daily regimens; p < 0.01). The other variables of adherence were also better among patients undergoing RADT in both those who took at least 80% of the pills (71.3% vs. 42.2%; p < 0.001) as well as those with good timing adherence (52.5% vs. 32.8%; p < 0.01). Furthermore, correct dosing was always greater when the patient had undergone an RADT. Adherence to antibiotic treatment is higher when an RADT is carried out at the consultation prior to administration of antibiotic treatment.
    Scandinavian journal of primary health care 03/2010; 28(1):12-7. · 2.21 Impact Factor
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    ABSTRACT: Abstract Background Excessive and inappropriate use of antibiotics is considered to be the most important reason for development of bacterial resistance to antibiotics. As antibiotic resistance may spread across borders, high prevalence countries may serve as a source of bacterial resistance for countries with a low prevalence. Therefore, bacterial resistance is an important issue with a potential serious impact on all countries. The majority of respiratory tract infections (RTIs) are treated in general practice. Most infections are caused by virus and antibiotics are therefore unlikely to have any clinical benefit. Several intervention initiatives have been taken to reduce the inappropriate use of antibiotics in primary health care, but the effectiveness of these interventions is only modest. Only few studies have been designed to determine the effectiveness of multifaceted strategies in countries with different practice setting. The aim of this study is to evaluate the impact of a multifaceted intervention targeting general practitioners (GPs) and patients in six countries with different prevalence of antibiotic resistance: Two Nordic countries (Denmark and Sweden), two Baltic Countries (Lithuania and Kaliningrad-Russia) and two Hispano-American countries (Spain and Argentina). Methods/Design HAPPY AUDIT was initiated in 2008 and the project is still ongoing. The project includes 15 partners from 9 countries. GPs participating in HAPPY AUDIT will be audited by the Audit Project Odense (APO) method. The APO method will be used at a multinational level involving GPs from six countries with different cultural background and different organisation of primary health care. Research on the effect of the intervention will be performed by analysing audit registrations carried out before and after the intervention. The intervention includes training courses on management of RTIs, dissemination of clinical guidelines with recommendations for diagnosis and treatment, posters for the waiting room, brochures to patients and implementation of point of care tests (Strep A and CRP) to be used in the GPs'surgeries. To ensure public awareness of the risk of resistant bacteria, media campaigns targeting both professionals and the public will be developed and the results will be published and widely disseminated at a Working Conference hosted by the World Association of Family Doctors (WONCA-Europe) at the end of the project period. Discussion HAPPY AUDIT is an EU-financed project with the aim of contributing to the battle against antibiotic resistance through quality improvement of GPs' diagnosis and treatment of RTIs through development of intervention programmes targeting GPs, parents of young children and healthy adults. It is hypothesized that the use of multifaceted strategies combining active intervention by GPs will be effective in reducing prescribing of unnecessary antibiotics for RTIs and improving the use of appropriate antibiotics in suspected bacterial infections.
    BMC Family Practice 01/2010; · 1.61 Impact Factor