Background and Aim: Respiratory
tract infection (RTI) is a common reason for consulting primary health care.
Antibiotic prescribing for RTIs varies among physicians indicating that
national guidelines are not always adhered to. The aim was to study if
antibiotic prescribing and use of near-patient tests were different among physicians who complete an audit registration and those who discontinue their
participation. Method:Aprospective cohort study where physicians
participated in an APO (Audit Project Odense) process, making an audit
registration for every appointment with a patient who had a respiratory tract
infection during 4 weeks in 2008 and 4 weeks in 2009. Between the registrations,
a limited educationally oriented intervention was made. 18 Primary Health
Care Centres located in three counties in southern of Sweden with 77 primary
health care physicians participated. When comparing proportions the Chisquare
test was used. Mann Whitney U-test was used when comparing independent groups
and Wilcoxon’s signed-rank test was used when comparing dependent groups.
Results:Of the 77 physicians, 38
participated only at baseline (group 1) and 39 participated in both registrations
(group 2). The overall use of CRP near-patient tests was 37% in group 1 and
28% in group 2 (Chisquare p < 0.001), and the overall use of Strep-A
near-patient tests was 31% and 20%, respectively (Chisquare p < 0.001).
When the Strep-A near-patient test was negative in pharyngitis/tonsillitis, antibiotics were prescribed to 45% in
group 1 and to 12% by group 2 (Chisquare 0.003). Conclusion:In conclusion, this study showed that
physicians, who were more inclined to complete audit participation, used
near-patient tests and prescribed antibiotics more correctly, according to the
national guidelines for respiratory tract infections, than physicians who
discontinued the participation. To achieve a rational use of antibiotics,
near-patient tests and prescription of antibiotics must be used according to
guidelines.
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