Post on 12-Aug-2020
Happy audit in Latvia:
prescribing of antibiotics in case of acute
respiratory diseases at primary health
care level
Jevgeņijs Bondins, Alise Nicmane-Aispure
Latvian Family Physicians’ Association
11.09.2015.
Happy Audit
This international project was :
-Funded by Swedish Institute (SI)
-Initiated by BARN (Baltic Antibiotic Resistance Networks).
- Supported by Latvian Family Physicians’ Association and Latvian
Disease Prevention and Control Centre
Participants:
• Lithuania,
• the Kaliningrad region of Russian Federation,
• The Southern Sweden,
• Poland
• Latvia
• in 2014 Joined in the 2nd registration: Estonia, Belarus and Moldova.
Happy Audit
The goal:
• To assess the Prescription of Antibiotics in GP practices for patients with
Acute Respiratory Tract Infections (ARTI)
• To optimize the prescription of antibiotics for ARTI
The method:
Audit Project Odense (APO) method designed for general practices for
quality assessment
Happy Audit
Happy Audit
activity circle:
How do we prescribe antibiotics for ARTI?
(1st. audit in 2012)
What could be
improved?
(Data analysis)
Spread of
information.
(Follow-up meeting,
individual reports)
Were changes
implemented?
(2nd. audit in 2014).
The key of this method is a registration form:
It is simple and easy to use.
It does not disturb the daily routine
takes little time to record the necessary information.
only short instruction for GP is necessary for each audit
it is anonymous (only ID number of Doctor is recorded)
Happy Audit
Inclusion criteria:
all patients with ARTI consulted by doctor during registration time,
max 100.
Exclusion:
- patients who receive antibiotics as ear or nasal solution form.
- consultation by telephone without patient visit
Happy Audit
1st. registration - in 2012 November-December:
- 56 Latvian GP participated, consultations 3414.
- Overall 238 doctors registered 13106 consultations for acute respiratory tract infections (ARTI).
During autumn 2013 were carried out follow‐ups:
- in Warsaw (overall report with the analysis) and Riga
-in Riga: report of Latvian results with the analysis and training for participants.
2nd. registration - in 2014. January – March:
- 36 Latvian GP participated (35 have participated in 2012), consultations 2062.
- Overall 245 doctors registered 11884 consultations for ARTI.
During autumn 2014 final follow‐up in Riga took place.
Were spread personal results to Latvian participants.
Happy Audit
Happy Audit 2012
4031 33
4964
0
10
20
30
40
50
60
70
All <7y. 8-17y. 18-49y. >50y.
Antibiotic prescription in different ages. In Latvia in %
Prescribed AB
Happy Audit 2012
0
10
20
30
40
50
60P
enic
ilin
Am
oks
i
Am
oks
i+C
lav.
Makr
ol
Hin
olo
ni
Doksi
Cef
alo
sp
Oth
er
AB prescription in different ages %, 2012, Latvia
<7
18-48
>50
Happy Audit 2012
The summary of Latvian results after HappyAudit 2012:
High level of antibiotic prescription
High prevalence of wide spectrum antibiotic prescription
Poor treatment with penicilin
Happy Audit 2012
Tonsilitis: -the usage of penicilin went
from only 5% to 47% in 2014 !!!
-wide range a/b decreased dramaticly:
Amoksi+clav from 11.9% to 2.9% and
Macrolides from 13.6 to 2.9
respectively.
Bronchitis: almost 50% No AB from
34% in 2012
OMA: - the difference of No AB is
almost 9%,
- treatment by penicilin increased (from
1 to 6.5%)
-50
-40
-30
-20
-10
0
10
20
30
40
50
Co
mm
on
co
ld
OM
A
Ph
ari
ngit
is
Ton
silit
s
Bron
chit
is
The deviation of AB prescription in % (age <7g.)
No AB
Others
Cefalosp
Hinoloni
Makrol
Amoksi+Clav.
Amoksi
Penicilin
Data analysis of HappyAudit 2012 and 2014
-40
-30
-20
-10
0
10
20
30
Co
mm
on
Cold
Ph
ari
ngit
is
OM
A
Bro
nchit
is
Pn
eim
onia
The deviation of AB prescription in % (age 18-49g.) Latvia
No AB
Others
Cefalosp
Doksi
Hinoloni
Makrol
Amoksi+Clav.
Amoksi
Penicilin
-Dropped AB prescription
for bronchitis (from 20% to
40%) and pneumonia up
to 10%,
-the usage of penicilin is
grown by 5% and 8% in
case of pharingitis and
tonsilitis respectively.
Data analysis of HappyAudit 2012 and 2014
The deviation of AB prescription in % (age >50.) Latvia
Common Cold Tonsilitis Bronchitis Pneimonia
20
12
20
14
20
12
20
14
20
12
20
14
20
12
20
14
Total
Number 50 46 24 11 103 40 84 29
Penicilin
0,0 0,0 0,0 18,2 1,0 0,0 0,0 0,0
Amoksi
4,0 10,9 20,8 27,3 25,2 22,5 19,0 13,8
Amoksi
+Clav.
8,0 8,7 16,7 36,4 22,3 15,0 35,7 44,8
Makrol
0,0 0,0 16,7 18,2 12,6 10,0 23,8 24,1
Hinoloni
0,0 0,0 0,0 0,0 0,0 2,5 4,8 0,0
Doksi 2,0 2,2 12,5 0,0 3,9 2,5 9,5 3,4
Cefalos
p 0,0 4,3 0,0 0,0 6,8 7,5 3,6 0,0
Others
0,0 0,0 4,2 0,0 1,9 0,0 4,8 3,4
No AB 86,0 71,7 29,2 0,0 26,2 35,0 0,0 10,3
-less a/b for
ac.bronchitis
- for ac.tonsilitis
penicilin prescription
is up to 18%
Data analysis of HappyAudit 2012 and 2014
-Penicilin popularity
increased from 2 to
10%
-the most popular
Amoksicilin
- went down the
usage of wide
spectrum antibiotics
Data analysis of HappyAudit 2012 and 2014
There is a progress in lowering the
prescription of antibiotics in Latvia.
Latvia compared to other countries:
Conclusion:
1. The penicillin prescription increased
2. Wide spectrum antibiotic usage diminished
3. Lowered overall antibiotic prescription rate
4. Dropped antibiotic usage in treatment of acute bronchitis
Happy Audit
The possible effects of the survey:
1. The penicilin for oral usage is become available in Latvia (in 2012 in
was not possible to buy it in pharmacy)
2. In 2014 Compared to 2012 the overall antibiotic prescription in
Latvian PHC is dropped down (according to data of Latvian National
Drug Agency)
3. Were developed the recomendations of antibiotic prescription for
children, with the close cooperation between GPs, infectologists and
pediatricians. It was presented for Family physicians.
4. In progress are leaflets for patients - for children first- how to act in
case of brochitis, OMA, tonsilitis
Happy Audit
hank you for your attention!
Antibiotic usage changes from 2010 to 2014 in Latvia.
According to data of 2013 - 85.3% of all
antibiotics were used in outpatient centres.
hank you for your attention!