ORCID Profile
0000-0002-8444-1369
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Research Unit of General Practice in Aalborg
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Aalborg University
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Publications
Introducing point-of-care ultrasound in Danish general practice—elucidating the use through a medical audit
Publisher: Oxford University Press (OUP)
Date: 25-08-2020
Abstract: Point-of-care ultrasonography (PoCUS) is increasingly used across the medical field. PoCUS is also being implemented in general practice despite a lack of clinical guidelines and training programs for general practitioners (GPs). This study aimed to elucidate the employment of PoCUS by Danish GPs following a short training program. Thirty GPs were enrolled in a short ultrasound training program and taught how to perform 22 selected scanning modalities. In the following 3 months, the GPs registered all performed PoCUS examinations according to the Audit Project Odense method. After 5 months, the GPs were invited to participate in an evaluation seminar, where questionnaires were distributed. During the registration period, 1598 patients were examined with PoCUS. A total of 1948 scanning modalities were registered, including 207 examinations outside the taught curriculum. The majority of the ultrasound examinations were performed within 10 minutes (89%), most were considered to be conclusive (87%) and/or to increase diagnostic certainty (67%), whereas one in four examinations entailed a change in patient management. Most GPs attending the evaluation seminar continued to use PoCUS and found the scanning modalities included in the course curriculum relevant in their daily work. The GPs found several indications for performing PoCUS following the attendance of a 2-day basic training program. The majority of examinations were registered to be conclusive and/or increase diagnostic certainty. However, few GPs used PoCUS on a daily basis and not all examinations were registered to have an impact on patient care.
Development of quality indicators for the diagnosis and treatment of urinary tract infections in general practice: a RAND appropriateness method
Publisher: BMJ
Date: 05-2023
DOI: 10.1136/BMJOQ-2022-002156
Abstract: To develop a set of quality indicators for the diagnosis and antibiotic treatment of adult patients with suspected urinary tract infections in general practice. A Research and Development/University of California Los Angeles appropriateness method was used. Danish general practice. A panel of nine experts, mainly general practitioners, was asked to rate the relevance of 27 preliminary quality indicators. The set of indicators was based on the most recent Danish guidelines for the management of patients with suspected urinary tract infection. An online meeting was held to resolve misinterpretations and achieve consensus. The experts were asked to rate the indicators on a nine-point Likert scale. Consensus of appropriateness was reached if the overall panel median rating was 7–9 with agreement. Agreement was defined as: no more than one expert rated the indicator outside the three-point region (1–3, 4–6 and 7–9) containing the median. A total of 23 of the 27 proposed quality indicators attained consensus. One additional indicator was proposed by the panel of experts, leading to a final set of 24 quality indicators. All indicators focusing on the diagnostic process achieved consensus of appropriateness, while the experts agreed on three quarters of the proposed quality indicators concerning either the treatment decision or the choice of antibiotics. This set of quality indicators may be used to strengthen general practice’s focus on the management of patients with a possible urinary tract infection and to identify potential quality problems.
Quality indicators for the diagnosis and antibiotic treatment of acute respiratory tract infections in general practice: a RAND Appropriateness Method
Publisher: Informa UK Limited
Date: 03-04-2017
Misconceptions and Knowledge Gaps on Antibiotic Use and Resistance in Four Healthcare Settings and Five European Countries—A Modified Delphi Study
Publisher: MDPI AG
Date: 11-09-2023
Quality assessment in general practice: diagnosis and antibiotic treatment of acute respiratory tract infections
Publisher: Informa UK Limited
Date: 02-10-2018
Parents' beliefs and knowledge about the management of acute otitis media: A qualitative study
Publisher: Springer Science and Business Media LLC
Date: 07-07-2015
Short‐course vs long‐course antibiotic treatment for community‐acquired pneumonia: A literature review
Publisher: Wiley
Date: 21-02-2019
DOI: 10.1111/BCPT.13205
Abstract: It is well known that antibiotic use is the main driver for the increasing problems with resistant bacteria. Consequently, some countries have recommended shortening the duration of antibiotic treatment of community-acquired pneumonia (CAP). The aim of this study was to investigate whether the effectiveness of a short-course antibiotic is comparable to a longer course of antibiotics in adults with CAP and to assess whether the duration of an antibiotic course influences the development of resistant bacteria. A literature search was performed in PubMed and EMBASE. We included randomized, controlled trials (RCTs) comparing clinical success, microbiological efficacy, patient safety and antibiotic resistance in a short-course (5 days) vs a long-course antibiotic treatment (7+ days) for CAP. Six RCTs were included. Clinical success rates were 87%-95% in patients treated with short-course antibiotics and 88%-94% in patients treated with a longer course. Eradication of pathogenic bacteria was found to be 100% and 95%-100% in patients treated with short-course and long-course antibiotics, respectively. No significant differences in adverse events were reported. However, none of the trials reported on the impact on the development of resistant bacteria. Only few trials were included in this review and more RCTs are highly needed to be able to provide solid evidence for optimal treatment durations for patients diagnosed with CAP. Importantly, fluoroquinolones were often the drug of choice, and trials testing beta-lactam antibiotics, which are the type of antibiotics most often used in many European countries, should be aimed for in near future.
Clinical indications for antibiotic use in Danish general practice
Publisher: Informa UK Limited
Date: 03-04-2017
Prescription of antibiotics to children with acute otitis media in Danish general practice
Publisher: Springer Science and Business Media LLC
Date: 27-08-2020
DOI: 10.1186/S12875-020-01248-0
Abstract: Acute otitis media (AOM) is a common and most often self-limiting infection in childhood, usually managed in general practice. Even though antibiotics are only recommended when certain diagnostic and clinical criteria are met a high antibiotic prescription rate is observed. The study’s objective was to analyse associations between patient- and general practitioner (GP) characteristics and antibiotic prescribing for children with AOM in an effort to explain the high antibiotic prescribing rates. All general practices in the Northern, Southern and Central regions of Denmark were invited to record symptoms, examinations, findings and antibiotic treatment for all children ≤7 years of age diagnosed with AOM during a four-week winter period in 2017/2018. Associations were analysed by means of multivariate logistic regressions. The study design was cross-sectional. GPs from 60 general practices diagnosed 278 children with AOM of whom 207 (74%) were prescribed antibiotics, most often penicillin V (60%). About half of the children had tympanometry performed. Antibiotic prescribing rates varied considerably between practices (0–100%). Antibiotic prescribing was associated with fever (odds ratio (OR) 3.69 95% confidence interval (CI) 1.93–7.05), purulent ear secretion (OR 2.35 95% CI 1.01–5.50) and poor general condition (OR 3.12 95% CI 1.31–7.46), and the practice’s antibiotic prescribing rate to other patients with symptoms of an acute respiratory tract infection (OR 2.85 CI 95% 1.07–7.60) and specifically to other children with AOM (OR 4.15 CI 95% 1.82–9.47). GPs’ antibiotic prescribing rates for children with AOM vary considerably even considering the of signs, symptoms, request for antibiotics, and use of tympanometry. Interventions to reduce overprescribing should be targeted high-prescribing practices.
Prescribing antibiotics: the use of diagnostic tests in general practice. A register-based study
Publisher: Informa UK Limited
Date: 02-10-2021
Treatment of acute otitis media in general practice: quality variations across countries
Publisher: Oxford University Press (OUP)
Date: 04-08-2011
Abstract: Recommendations for antibiotic treatment of acute otitis media (AOM) have changed over the years, and today many experts recommend initial observation. However, antibiotic prescribing should be considered in children aged 38.5°C, ear discharge and the antibiotic treatment given was recorded. Danish GPs had the lowest antibiotic prescription rate for AOM [72.7% (95% confidence interval (CI) = 67.0-77.8)] and GPs in Kaliningrad had the highest [97.1% (95% CI = 89.8-99.6)]. Narrow-spectrum penicillin was almost exclusively prescribed in the two Nordic countries, while broad-spectrum penicillins, often in combination with clavulanic acid, were prescribed in the other four countries. Macrolides comprised 5-10% of prescriptions. Antibiotic prescribing was associated with the following characteristics of the patients: symptoms for >3 days, ear discharge and fever. The majority of patients with AOM were treated with antibiotics in all six countries, but considerable variations in both prescribing rate and choice of antibiotics were identified.
Antibiotic treatment of community‐acquired pneumonia: A questionnaire survey in Danish general practice
Publisher: Wiley
Date: 16-11-2021
DOI: 10.1111/BCPT.13684
Abstract: Discrepancies exist in Danish guidelines for the treatment of bacterial community‐acquired pneumonia (CAP). This study aimed to investigate how general practitioners (GPs) treat adults with CAP and explore associations between GP characteristics and treatment duration. In autumn 2020, GPs in the North Denmark Region were asked to complete an electronic questionnaire on antibiotic prescribing for CAP. Information about GP gender, age, experience and type of practice was obtained. Multivariable logistic regression was used to analyse the association between GP characteristics and treatment duration. A total of 298 GPs were invited to participate of whom 108 completed the survey. Penicillin V was used as first line treatment for CAP by all participants. Treatment duration varied from 5 (54.6%) to 10 days (8.3%). A 5‐day course of penicillin was less likely to be prescribed by male GPs (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.13–0.94) and more likely to be prescribed by GPs with 5–9 years of experience in general practice (OR 5.03, 95% CI 1.09–23.21) compared to those with 10–19 years of experience. Variation in antibiotic treatment of CAP emphasises the importance of generating solid evidence about the optimal duration regarding both effectiveness and safety.
Use and quality of point-of-care microscopy, urine culture and susceptibility testing for urinalysis in general practice
Publisher: Informa UK Limited
Date: 02-01-2022
Danish GPs’ and practice nurses’ management of acute sore throat and adherence to guidelines
Publisher: Oxford University Press (OUP)
Date: 19-06-2018
Abstract: Sore throat is a frequent presentation of acute respiratory tract infections in general practice. Though these infections are often harmless and self-limiting, antibiotics are frequently prescribed. In Denmark, practice nurses manage an increasing part of patients with acute minor illnesses. We aimed (i) to investigate Danish practice nurses' and GPs' management of patients presenting with a sore throat and (ii) to explore to what extent management is according to current Danish guidelines. A cross-sectional study was conducted during winter 2017, involving GPs and practice nurses in Danish general practices. Patients with a sore throat were registered according to the Audit Project Odense method. A total of 44 practices participated with the registration of 1503 patients presenting with a sore throat. Most patients had a strep A test performed, especially when managed by a practice nurse (84.6% versus 61.8%, χ2 = 90.1, P < 0.05). In total, 40.6% of performed strep A tests were not according to guideline recommendations. Antibiotics were prescribed for about one-third of patients, regardless whether managed by a practice nurse or a GP (χ2 = 0.33, P = 0.57). However, 32.4% of these prescriptions were not in line with Danish guidelines. Patients with acute sore throat were managed similarly by GPs and practice nurses, apart from a higher use of strep A tests in patients seen by practice nurses. Importantly, this study demonstrated that there is still room for improvement of the management of these patients in Danish general practice.
Antibiotic prescribing in Danish general practice 2004-13
Publisher: Oxford University Press (OUP)
Date: 21-04-2016
DOI: 10.1093/JAC/DKW117
Quality assessment of diagnosis and antibiotic treatment of infectious diseases in primary care: a systematic review of quality indicators
Publisher: Informa UK Limited
Date: 02-07-2016
DOI: 10.1080/02813432.2016.1207143
Abstract: To identify existing quality indicators (QIs) for diagnosis and antibiotic treatment of patients with infectious diseases in primary care. A systematic literature search was performed in PubMed and EMBASE. We included studies with a description of the development of QIs for diagnosis and antibiotic use in patients with infectious diseases in primary care. We extracted information about (1) type of infection (2) target for quality assessment (3) methodology used for developing the QIs and (4) whether the QIs were developed for a national or international application. The QIs were organised into three categories: (1) QIs focusing on the diagnostic process (2) QIs focusing on the decision to prescribe antibiotics and (3) QIs concerning the choice of antibiotics. Eleven studies were included in this review and a total of 130 QIs were identified. The majority (72%) of the QIs were focusing on choice of antibiotics, 22% concerned the decision to prescribe antibiotics, and few (6%) concerned the diagnostic process. Most QIs were either related to respiratory tract infections or not related to any type of infection. A consensus method (mainly the Delphi technique), based on either a literature study or national guidelines, was used for the development of QIs in all of the studies. The small number of existing QIs predominantly focuses on the choice of antibiotics and is often drug-specific. There is a remarkable lack of diagnostic QIs. Future development of new QIs, especially disease-specific QIs concerning the diagnostic process, is needed. KEY POINTS In order to improve the use of antibiotics in primary care, measurable instruments, such as quality indicators, are needed to assess the quality of care being provided. A total of 11 studies were found, including 130 quality indicators for diagnosis and antibiotic treatment of infectious diseases in primary care. The majority of the identified quality indicators were focusing on the choice of antibiotics and only a few concerned the diagnostic process. All quality indicators were developed by means of a consensus method and were often based on literature studies or guidelines.
Quality indicators for diagnosis and treatment of respiratory tract infections in general practice: A modified Delphi study
Publisher: Informa UK Limited
Date: 2010
Quality indicators for treatment of respiratory tract infections? An assessment by Danish general practitioners
Publisher: Informa UK Limited
Date: 16-10-2012
DOI: 10.3109/13814788.2012.730515
Abstract: In 2008, a set of 41 quality indicators for antibiotic treatment of respiratory tract infections (RTIs) in general practice were developed in an international setting as part of the European project HAPPY AUDIT. To investigate Danish general practitioners' (GPs') assessment of a set of internationally developed quality indicators and to explore if there is an association between the GPs' assessment of the indicators and their practice characteristics as well as their antibiotic prescription pattern. A total of 102 Danish GPs were invited to assess the 41 quality indicators. The GPs were categorized into two groups according to their assessment of indicators. Data concerning practice characteristics and antibiotic treatment were obtained during a three-week registration of patients with RTIs and were linked to the GPs' assessments of the indicators. A total of 62 (61%) responded. Quality indicators focusing on the frequency of prescribing of narrow-spectrum penicillin were rated as suitable by more than 80% of the Danish GPs, while quality indicators concerning cephalosporins or quinolones were rated suitable by less than half of the GPs. The antibiotic prescribing pattern differed significantly and the GPs who disagreed on most indicators prescribed more macrolides and less narrow-spectrum penicillin than the GPs who agreed on most indicators. Even though an international expert panel agreed on a set of quality indicators for antibiotic treatment of RTIs, only a few of them were rated suitable by the GPs, who are supposed to use them.
General Practitioner Antimicrobial Stewardship Programme Study (GAPS): protocol for a cluster randomised controlled trial
Publisher: Springer Science and Business Media LLC
Date: 21-04-2016
Health alliance for prudent prescribing and yield of antibiotics in a patient-centred perspective (HAPPY PATIENT): a before-and-after intervention and implementation study protocol
Publisher: Springer Science and Business Media LLC
Date: 02-05-2022
DOI: 10.1186/S12875-022-01710-1
Abstract: Excessive and inappropriate use of antibiotics is the most important driver of antimicrobial resistance. The aim of the HAPPY PATIENT project is to evaluate the adaptation of European Union (EU) recommendations on the prudent use of antimicrobials in human health by evaluating the impact of a multifaceted intervention targeting different categories of healthcare professionals (HCPs) on common community-acquired infectious diseases, especially respiratory and urinary tract infections. HAPPY PATIENT was initiated in January 2021 and is planned to end in December 2023. The partners of this project include 15 organizations from 9 countries. Diverse HCPs (doctors, nurses, pharmacists, and pharmacy technicians) will be audited by the Audit Project Odense (APO) method before and after an intervention in four different settings: general practice, out of hours services, nursing homes and community pharmacies in four high antibiotic prescribing countries (France, Poland, Greece, and Spain) and one low prescribing country (Lithuania). About 25 in iduals from each professional group will be recruited in each country, who will register at least 25 patients with community-acquired infections during each audit period. Shortly before the second registration participants will undertake a multifaceted intervention and will receive the results from the first registration to allow the identification of possible quality problems. At these meetings participants will receive training courses on enhancement of communication skills, dissemination of clinical guidelines with recommendations for diagnosis and treatment, posters for the waiting rooms, and leaflets for patients. The results of the second registration will be compared with those obtained in the first audit. HAPPY PATIENT is an EU-funded project aimed at contributing to the battle against antibiotic resistance through improvement of the quality of management of common community-acquired infections based on interventions by different types of HCPs. It is hypothesized that the use of multifaceted strategies combining active intervention will be effective in reducing inappropriate prescribing and dispensing of antibiotics. EU Health programmes project database webgate.ec.europa.eu/chafea_pdb/health rojects/900024/summary date of registration: 1 January 2021.
Danish guidelines on management of otitis media in preschool children
Publisher: Elsevier BV
Date: 08-2016
DOI: 10.1016/J.IJPORL.2016.06.003
Abstract: Otitis media is one of the most common diseases in small children. This underlines the importance of optimizing diagnostics and treatment of the condition. Recent literature points toward a stricter approach to diagnosing acute otitis media (AOM). Moreover, ventilating tube treatment for recurrent AOM (RAOM) and chronic otitis media with effusion (COME) has become the most frequently performed surgical procedure in pre-school children. Therefore, the Danish Health and Medicines Authority and the Danish Society of Otorhinolaryngology, Head and Neck Surgery deemed it necessary to update the Danish guidelines regarding the diagnostic criteria for acute otitis media and surgical treatment of RAOM and COME. The GRADE system (The Grading of Recommendations Assessment, Development and Evaluation) was used in order to comply with current standards of evidence assessment in formulation of recommendations. An extensive literature search was conducted between July and December 2014. The quality of the existing literature was assessed using AGREE II (Appraisal of Guidelines for Research & Evaluation), AMSTAR (assessing the Methodological Quality of Systematic Reviews), QUADAS-2 (Quality of Diagnostic Accuracy Studies), Cochrane Risk of Bias Tool for randomized trials and ACROBAT-NRSI (A Cochrane Risk of Bias Assessment Tool for Non-Randomized Studies). The working group consisted of otolaryngologists, general practitioners, pediatricians, microbiologists and epidemiologists. Recommendations for AOM diagnosis, surgical management for RAOM and COME, including the role of adenoidectomy and treatment of ventilating tube otorrhea, are proposed in the guideline.
Danish GPs’ Experiences When Managing Patients Presenting to General Practice with Symptoms of Acute Lower Respiratory Tract Infections: A Qualitative Study
Publisher: MDPI AG
Date: 06-2021
DOI: 10.3390/ANTIBIOTICS10060661
Abstract: One of the most common indications for antibiotic prescribing in general practice is acute lower respiratory tract infections (LRTI). This study aimed to explore general practitioners’ (GPs’) considerations and experiences when managing patients with symptoms of an acute LRTI. In idual semi-structured interviews were conducted with seven GPs in the North Denmark Region from January to March 2020. Data were analysed by means of systematic text condensation. The analysis revealed four themes: (1) practicalities of assessing patients with LRTI, (2) assessment of the patient, (3) treatment decisions, and (4) patient expectations. The GPs described having developed in idual diagnostic strategies and routines when managing patients with symptoms of an acute LRTI. However, a general assessment of the patient was essential to all the GPs and the diagnosis was seldom based on a single symptom or finding. Most GPs described having great faith in abnormal lung auscultation. The use of C-reactive protein testing served several purposes, such as deciding on the severity of the infection, prescribing antibiotics or not, and as a communicative tool. Diagnostic uncertainty is a driver of antibiotic use and clinical practice might benefit from the development of clinical prediction rules for diagnosing pneumonia.
Adverse events in people taking macrolide antibiotics versus placebo for any indication
Publisher: Wiley
Date: 18-01-2019
Association between prescribing patterns of anti-asthmatic drugs and clinically uncontrolled asthma: A cross-sectional study
Publisher: Elsevier BV
Date: 12-2011
DOI: 10.1016/J.PUPT.2011.09.001
Abstract: Studies based on prescription data have shown that many asthmatics tend to use large quantities of inhaled beta-2-agonists, suggesting poorly controlled disease. The aim of the present study was to investigate the association between clinically uncontrolled asthma and prescribing patterns of anti-asthmatic drugs with a primary focus on short-acting beta-2-agonists (SABA). In a cross-sectional study 357 subjects, selected by their prescriptions of inhaled beta-2-agonists in Odense Pharmaco-Epidemiological Database, underwent in idual clinical assessment including the Asthma Control Questionnaire (ACQ) and spirometry. The associations between uncontrolled asthma (ACQ score ≥ 1.50) and in idual anti-asthmatic prescribing were analysed by means of logistic regression. Clinically uncontrolled asthma was positively associated with SABA use, the association becoming stronger with higher annual quantity of SABA use, odds ratio (OR) 11.1 (95% CI 4.4-28.0) for ≥400 DDD/year. This trend persisted after stratifying for gender, age, and controller treatment. Although subjects using ≥450 DDD/year were all uncontrolled, there was substantial overlap in SABA use between controlled and uncontrolled subjects below this limit. We found no effect modification by age and gender. Use of inhaled corticosteroids protected against uncontrolled asthma, OR 0.51 (95% CI 0.27-0.95). Asthmatics with a high use of SABA frequently have problems with uncontrolled asthma, and users of ICS are protected against uncontrolled asthma. The associations we found were, however, to weak too allow firm conclusions about asthma control for most in idual asthma patients.
Changes in Antibiotic Prescribing Patterns in Danish General Practice during the COVID-19 Pandemic: A Register-Based Study
Publisher: MDPI AG
Date: 13-11-2022
DOI: 10.3390/ANTIBIOTICS11111615
Abstract: The World Health Organization expressed concern that antimicrobial resistance would increase during the COVID-19 pandemic due to the excessive use of antibiotics. This study aimed to explore if antibiotic prescribing patterns in general practices located in the North Denmark Region changed during the COVID-19 pandemic. The study was conducted as a registry-based study. Data was collected for every antibiotic prescription issued in general practices located in the North Denmark Region during the first year of the pandemic (1 February 2020 to 31 January 2021) and the year prior to the pandemic (1 February 2019 to 31 January 2020). Data were compared regarding antibiotic agents and the type of consultation linked to each antibiotic prescription. Results showed that antibiotic prescriptions decreased by 18.5% during the first pandemic year. The use of macrolides and lincosamides, along with combinations of penicillins and beta-lactamase -sensitive penicillins, was reduced the most. Face-to-face consultations related to an antibiotic prescription decreased by 28.5%, while the use of video consultations increased markedly. In Denmark, COVID-19 restrictions have contributed to both a lower consumption of antibiotics and a change in prescription patterns in general practice. Probably some of the COVID-19 -preventing initiatives could be of importance moving forward in the fight against antimicrobial resistance.
How to improve practice by means of the Audit Project Odense method
Publisher: Royal College of General Practitioners
Date: 28-04-2022
Initial symptoms and three months follow-up after acute COVID-19 in outpatients: An international prospective cohort study
Publisher: Informa UK Limited
Date: 19-01-2023
Characterisation of antibiotic prescriptions for acute respiratory tract infections in Danish general practice: a retrospective registry based cohort study
Publisher: Springer Science and Business Media LLC
Date: 19-05-2017
DOI: 10.1038/S41533-017-0037-7
Abstract: Inappropriate use of antibiotics is contributing to the increasing rates of antimicrobial resistance. Several Danish guidelines on antibiotic prescribing for acute respiratory tract infections in general practice have been issued to promote rational prescribing of antibiotics, however it is unclear if these recommendations are followed. We aimed to characterise the pattern of antibiotic prescriptions for patients diagnosed with acute respiratory tract infections, by means of electronic prescriptions, labeled with clinical indications, from Danish general practice. Acute respiratory tract infections accounted for 456,532 antibiotic prescriptions issued between July 2012 and June 2013. Pneumonia was the most common indication with 178,354 prescriptions (39%), followed by acute tonsillitis (21%) and acute otitis media (19%). In total, penicillin V accounted for 58% of all prescriptions, followed by macrolides (18%) and amoxicillin (15%). The use of second-line agents increased with age for all indications, and comprised more than 40% of the prescriptions in patients aged years. Women were more often prescribed antibiotics regardless of clinical indication. This is the first Danish study to characterise antibiotic prescription patterns for acute respiratory tract infections by data linkage of clinical indications. The findings confirm that penicillin V is the most commonly prescribed antibiotic agent for treatment of patients with an acute respiratory tract infection in Danish general practice. However, second-line agents like macrolides and amoxicillin with or without clavulanic acid are overused. Strategies to improve the quality of antibiotic prescribing especially for pneumonia, acute otitis media and acute rhinosinusitis are warranted.
Development over time in point-of-care test use in Danish daytime and out-of-hours general practice: a register-based study
Publisher: Informa UK Limited
Date: 20-03-2023
Reducing antibiotic prescribing in general practice in Australia: a cluster randomised controlled trial of a multimodal intervention
Publisher: CSIRO Publishing
Date: 2023
DOI: 10.1071/PY23024
Predictors for antibiotic prescribing in patients with exacerbations of COPD in general practice
Publisher: SAGE Publications
Date: 16-01-2013
Abstract: The aim of this study was to describe the antibiotic prescribing rate in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), to analyse predictors for antibiotic prescribing and to explore the influence of the use C-reactive protein (CRP) rapid test. A cross-sectional study was carried out in January and February 2008 in primary care. General practitioners (GPs) from six countries (Denmark, Sweden, Lithuania, Russia, Spain and Argentina) registered all patients with AECOPD during a 3-week period. A multilevel logistic regression model was estimated using two hierarchical levels, (i) patients and (ii) physicians, and was used to analyse the association between antibiotic prescribing and potential predictors for antibiotic use: patients’ age and gender, duration and symptoms and signs of exacerbations (fever, cough, dyspnoea, sputum volume and purulence) and the results of the CRP test. A total of 617 GPs registered 1233 patients with AECOPD. A total of 970 patients (79%) were prescribed antibiotics, varying from 49% (Denmark) to 93% (Russia). The presence of purulent sputum was the strongest predictor for antibiotic treatment (odds ratio [OR] 8.7 95% confidence interval [CI] 5.9–12.8). CRP determination was carried out mainly in Denmark and Sweden and its use was the strongest protective factor for antibiotic therapy (OR 0.3 95% CI 0.2-0.6). GPs that used CRP testing weighted purulent sputum lower than GPs who did not use CRP testing. CRP values had a strong influence on the antibiotic prescribing rate. Antibiotic treatment for AECOPD is very high. This study shows that GPs performing CRP rapid tests prescribe fewer antibiotics than those who do not.
Health Alliance for prudent antibiotic prescribing in patients with respiratory tract infections (HAPPY AUDIT) -impact of a non-randomised multifaceted intervention programme
Publisher: Springer Science and Business Media LLC
Date: 20-06-2011
Misconceptions and Knowledge Gaps on Antibiotic Use in Primary Care – a Delphi Study in Four Sectors and Five European Countries
Publisher: MDPI AG
Date: 18-07-2023
DOI: 10.20944/PREPRINTS202307.1235.V1
Abstract: Background: Misconceptions and knowledge gaps about antibiotic use contribute to inappropriate antibiotic use and antimicrobial resistance. Aim: Identifying and prioritizing misconceptions and knowledge gaps about antibiotic use from a healthcare professionals’ perspective. Methods: A modified Delphi study of two rounds with an expert meeting. A literature search was conducted to create statements about misconceptions and knowledge gaps about antibiotic use. These were rated by healthcare professionals from five EU countries representing general practice, out-of-hour services, nursing homes, and pharmacies. Consensus was achieved if ≥80% of the participants rated 4+ on a five-point Likert scale during the second Delphi round. Results. In total, 44 misconceptions were identified through the literature search within four themes: 1) antimicrobial resistance in general, 2) use of antibiotics in general, 3) use of antibiotics for respiratory tract infections, and 4) use of antibiotics for urinary tract infections. Consensus was reached for more than half of the statements within each setting. Conclusions. Experts from different settings and nationalities acknowledge that multiple misconceptions and knowledge gaps can contribute to inappropriate use of antibiotics in the community. These results provide valuable information to use in educational c aigns for patients and healthcare professionals to improve the use of antibiotics.
Diagnosis and Antibiotic Treatment of Urinary Tract Infections in Danish General Practice: A Quality Assessment
Publisher: MDPI AG
Date: 05-12-2022
DOI: 10.3390/ANTIBIOTICS11121759
Abstract: Rational antibiotic treatment of urinary tract infections (UTI) is important. To improve the quality of antibiotic treatment of UTI, it is essential to obtain insight into diagnostic approaches and prescribing patterns in general practice. The aim of this study was to investigate the quality of diagnostics and treatment of UTI in general practice by means of quality indicators (QIs). QIs provide a quantitative measure of quality and are defined by a numerator (the number of patients receiving a specific investigation or treatment) and a denominator (the number of patients included in the quality assessment). For adult patients with suspected UTI, practices registered the following: age, sex, risk factors, symptoms and signs, examinations, diagnosis and treatment. The levels of the QIs were compared with their corresponding standards. Half of the patients diagnosed with lower UTI or pyelonephritis fulfilled the diagnostic criteria for UTI: characteristic UTI symptoms and clear signs of bacteriuria, respectively. Urinalysis was performed for nearly all patients, including patients without characteristic symptoms of UTI. One-fourth of the patients with suspected lower UTI were treated with antibiotics despite no urinalysis and nearly half received antibiotics despite an inconclusive dipstick test. Pivmecillam was the preferred antibiotic. The findings of this study indicate that there is room for improvement in the management of UTI in Danish general practice.
Factors associated with C-reactive protein testing when prescribing antibiotics in general practice: a register-based study
Publisher: Springer Science and Business Media LLC
Date: 22-01-2022
DOI: 10.1186/S12875-021-01614-6
Abstract: The use of C-reactive protein (CRP) tests has been shown to safely reduce antibiotic prescribing for acute respiratory tract infections (RTIs). The aim of this study was to explore patient and clinical factors associated with the use of CRP testing when prescribing antibiotics recommended for RTIs. A nation-wide retrospective cross-sectional register-based study based on first redeemed antibiotic prescriptions issued to adults in Danish general practice between July 2015 and June 2017. Only antibiotics recommended for treatment of RTIs were included in the analysis (penicillin-V, amoxicillin, co-amoxicillin or roxithromycin/clarithromycin). Logistic regression models were used to estimate odds ratios for patient-related and clinical factors on performing a CRP test in relation to antibiotic prescribing. A total of 984,149 patients redeemed at least one antibiotic prescription during the two-year period. About half of these prescriptions (49.6%) had an RTI stated as the indication, and a CRP test was performed in relation to 45.2% of these scripts. Lower odds of having a CRP test performed in relation to an antibiotic prescription was found for patients aged 75 years and above (OR 0.82, 95CI 0.79–0.86), with a Charlson Comorbidity Index of more than one (OR 0.93, 95CI 0.91–0.95), unemployed or on disability pension (OR 0.84, 95CI 0.83–0.85) and immigrants (OR 0.91, 95CI 0.88–0.95) or descendants of immigrants (OR 0.90, 95CI 0.84–0.96). Living with a partner (OR 1.08, 95CI 1.07–1.10), being followed in practice for a chronic condition (OR 1.22, 95CI 1.18–1.26) and having CRP tests performed in the previous year (OR 1.78, 95CI 1.73–1.84) were associated with higher odds of CRP testing in relation to antibiotic prescribing. Differences were observed in the use of CRP tests among subgroups of patients indicating that both sociodemographic factors and comorbidity influence the decision to use a CRP test in relation to antibiotic prescriptions in general practice. Potentially, this means that the use of CRP tests could be optimised to increase diagnostic certainty and further promote rational prescribing of antibiotics. The rationale behind the observed differences could be further explored in future qualitative studies.
Prescribing antibiotics: Factors driving decision-making in general practice. A discrete choice experiment
Publisher: Elsevier BV
Date: 07-2022
DOI: 10.1016/J.SOCSCIMED.2022.115033
Abstract: Antimicrobial resistance is a threat to human health. We need to strive for a rational use of antibiotics to reduce the selection of resistant bacteria. Most antibiotics are prescribed in general practice, but little is known about factors influencing general practitioners' (GPs) decision-making when prescribing antibiotics. To 1) assess the importance of factors that influence decisions by GPs to prescribe antibiotics for acute respiratory tract infections (RTIs) and 2) identify segments of GPs influenced differently when deciding to prescribe antibiotics. A questionnaire survey including a discrete choice experiment was conducted. Danish GPs were asked to indicate whether they would prescribe antibiotics in six hypothetical choice sets with six variables: whether the GP is behind schedule, patient's temperature, patient's general condition, lung auscultation findings, C-reactive protein (CRP) level, and whether the patient expects antibiotics. Error component and latent class models were estimated and the probabilities of prescribing in different scenarios were calculated. The questionnaire was distributed to every Danish GP (n = 3,336) 1,152 (35%) responded. Results showed that GPs were influenced by (in prioritised order): CRP level (Relative importance (RI) 0.54), patient's general condition (RI 0.20), crackles at auscultation (RI 0.15), and fever (RI 0.10). Being behind schedule and patient expectations had no significant impact on antibiotic prescription at the aggregate level. The latent class analysis identified five classes of GPs: generalists, CRP-guided, general condition-guided, reluctant prescribers, and stethoscopy-guided. For all classes, CRP was the most important driver, while GPs were heterogeneously affected by other drivers. The most important factor affecting Danish GPs' decision to prescribe antibiotics at the aggregate level, in subgroups of GPs, and across latent classes was the CRP value. Hence, the use of CRP testing is an important factor to consider in order to promote rational antibiotic use in the battle against antimicrobial resistance.
Identifying practice-related factors for high-volume prescribers of antibiotics in Danish general practice
Publisher: Oxford University Press (OUP)
Date: 19-04-2017
DOI: 10.1093/JAC/DKX115
Developing a Tool for Auditing the Quality of Antibiotic Dispensing in Community Pharmacies: A Pilot Study
Publisher: MDPI AG
Date: 27-09-2022
DOI: 10.20944/PREPRINTS202209.0406.V1
Abstract: Background. The European Centre for Disease Prevention and Control describes the community pharmacist as gatekeeper to the quality of antibiotic use. The pharmacist has the responsibility to guard safe and effective antibiotic use however, little is known about how this is implemented in practice. Aims. To assess the feasibility of a method to audit the quality of antibiotic dispensing in community pharmacy practice and to explore antibiotic dispensing practices in Greece, Lithuania, Poland, and Spain. Methods. The Audit Project Odense methodology to audit antibiotic dispensing practice was adapted for use in community pharmacy practice. Community pharmacists registered antibiotic dispensing on a specifically developed registration chart and were asked to provide feedback on the registration method. Results. Altogether twenty pharmacists were recruited in four countries. They registered a total of 409 dispenses of oral antibiotics. Generally, pharmacists were positive about the feasibility of implementing the registration chart in practice. The frequency of checking for allergies, contraindications and interactions differed largely between the four countries. Pharmacists provided little advice to patients. The pharmacists rarely contacted prescribers. Conclusion. This tool seems to make it possible to get a useful picture of antibiotic dispensing patterns in community pharmacies. Dispensing practice does not seem to correspond with EU guidelines according to these preliminary results.
Increased demand of urine cultures from Danish general practice: a five-year register-based study
Publisher: Informa UK Limited
Date: 03-04-2023
Factors Associated with Antibiotic Prescribing in Children with Otitis Media
Publisher: Hindawi Limited
Date: 26-02-2013
DOI: 10.5402/2013/587452
Abstract: Background . Acute otitis media (AOM) is often treated with antibiotics. However, initial observation is recommended. Denmark has a low use of antibiotics compared with other countries, but the total use of antibiotics has increased by 32% during the last decade, and it is important to know whether general practitioners (GPs) prescribe antibiotics according to guidelines. Objective . The aim of the study was to analyse associations between GPs' antibiotic prescribing for AOM and symptoms, diagnoses, and characteristics of children. Methods . A cohort study where GPs consecutively included 954 children between 0 and 7 years old with a new ear symptom was carried out. The GPs registered symptoms, results of otoscopy and tympanometry, together with diagnosis and treatment. Results . Fever with and without earache was statistically associated with prescribing antibiotics, and it applies to both children up to two years of age (OR: 5.89 (confidence interval (CI): 2.62–13.21) and OR: 8.13 (CI: 4.61–14.32)) and children older than two years of age (OR: 4.59 (CI: 2.55–8.25) and OR: 19.45 (CI: 6.38–59.24)). A red tympanic membrane was statistically associated with the prescribing antibiotics in both age groups (0–2 years: OR: 4.73 (CI: 2.52–8.86) and –7 years: OR: 3.76 (CI: 2.13–6.64)). A flat tympanometry curve was only statistically associated with prescribing antibiotics in the oldest children (OR: 2.42 (CI: 1.17–5.00)). Conclusion . This study indicates that GPs to a large degree prescribe antibiotics appropriately according to guidelines.
C-reactive protein cut-offs used for acute respiratory infections in Danish general practice
Publisher: Royal College of General Practitioners
Date: 24-11-2020
DOI: 10.3399/BJGPOPEN20X101136
Abstract: GPs can use the C-reactive protein (CRP) point-of-care test (POCT) to assist when deciding whether to prescribe antibiotics for patients with acute respiratory tract infections (RTIs). To estimate the CRP cut-off levels that Danish GPs use to guide antibiotic prescribing for patients presenting with different signs and symptoms of RTIs. A cross-sectional study conducted in general practice in Denmark. During the winters of 2017 and 2018, 143 GPs and their staff registered consecutive patients with symptoms of an RTI according to the Audit Project Odense (APO) method. CRP cut-offs were estimated as the lowest level at which half of the patients were prescribed an antibiotic. In total, 7813 patients were diagnosed with an RTI, of whom 4617 (59%) had a CRP test performed. At least 25% of the patients were prescribed an antibiotic when the CRP level was mg/L, at least 50% when CRP was mg/L, and at least 75% when CRP was mg/L. Lower thresholds were identified for patients aged ≥65 years and those presenting with a fever, poor general appearance, dyspnoea, abnormal lung auscultation, or ear/facial pain, and if the duration of symptoms was either short (≤1 day) or long ( days). More than half of patients presenting to Danish general practice with symptoms of an RTI have a CRP test performed. At CRP levels mg/L, the majority of patients have an antibiotic prescribed.
Accuracy of lung ultrasonography in the hands of non-imaging specialists to diagnose and assess the severity of community-acquired pneumonia in adults: a systematic review
Publisher: BMJ
Date: 06-2020
DOI: 10.1136/BMJOPEN-2019-036067
Abstract: We aimed to systematically review the published literature regarding adults with clinical suspicion of pneumonia that compares the accuracy of lung ultrasonography (LUS) performed by non-imaging specialists to other reference standards in diagnosing and evaluating the severity of community-acquired pneumonia. Moreover, we aimed to describe LUS training and the speciality of the physician performing LUS, time spent on the LUS procedure and potential harms to patients. We searched MEDLINE, Embase, CINAHL, Web of Science and Cochrane Central Register of Controlled Trials up until May 2019. We included studies that used LUS to diagnose pneumonia, but also confirmed pneumonia by other means. Publications were excluded if LUS was performed by a sonographer or radiologist (imaging specialists) or performed on other indications than suspicion of pneumonia. Two review authors screened and selected articles, extracted data and assessed quality using Quality Assessment of Diagnostic Accuracy Studies 2. We included 17 studies. The sensitivity of LUS to diagnose pneumonia ranged from 0.68 to 1.00 however, in 14 studies, sensitivity was ≥0.91. Specificities varied from 0.57 to 1.00. We found no obvious differences between studies with low and high diagnostic accuracy. The non-imaging specialists were emergency physicians, internal medicine physicians, intensivists or ‘speciality not described’. Five studies described LUS training, which varied from a 1-hour course to fully credentialed ultrasound education. In general, the methodological quality of studies was good, though, some studies had a high risk of bias. We found significant heterogeneity across studies. In the majority of studies, LUS in the hands of the non-imaging specialists demonstrated high sensitivities and specificities in diagnosing pneumonia. However, due to problems with methodology and heterogeneity there is a need for larger studies with uniform and clearly established criteria for diagnosis and blinding. Prospectively registered in PROSPERO (CRD42017057804).
Developing a Tool for Auditing the Quality of Antibiotic Dispensing in Community Pharmacies: A Pilot Study
Publisher: MDPI AG
Date: 11-2022
DOI: 10.3390/ANTIBIOTICS11111529
Abstract: Background: The European Centre for Disease Prevention and Control describes the community pharmacist as the gatekeeper to the quality of antibiotic use. The pharmacist has the responsibility to guard safe and effective antibiotic use however, little is known about how this is implemented in practice. Aims: To assess the feasibility of a method to audit the quality of antibiotic dispensing in community pharmacy practice and to explore antibiotic dispensing practices in Greece, Lithuania, Poland, and Spain. Methods: The Audit Project Odense methodology to audit antibiotic dispensing practice was adapted for use in community pharmacy practice. Community pharmacists registered antibiotic dispensing on a specifically developed registration chart and were asked to provide feedback on the registration method. Results: Altogether, twenty pharmacists were recruited in four countries. They registered a total of 409 dispenses of oral antibiotics. Generally, pharmacists were positive about the feasibility of implementing the registration chart in practice. The frequency of checking for allergies, contraindications and interactions differed largely between the four countries. Pharmacists provided little advice to patients. The pharmacists rarely contacted prescribers. Conclusion: This tool seems to make it possible to get a useful picture of antibiotic dispensing patterns in community pharmacies. Dispensing practice does not seem to correspond with EU guidelines according to these preliminary results.
Acute lower respiratory tract infections: Symptoms, findings and management in Danish general practice
Publisher: Informa UK Limited
Date: 25-10-2019
Health Alliance for Prudent Prescribing, Yield and Use of Antimicrobial Drugs in the Treatment of Respiratory Tract Infections (HAPPY AUDIT)
Publisher: Springer Science and Business Media LLC
Date: 23-04-2010
Related Organisations
Section Of General Practice And Research Unit For General Practice
Location: Denmark
Related Funding Activities
No related grants have been discovered for Malene Plejdrup Hansen.