Guidelines observance by general practitioners for respiratory tract infections: a quantitative study using the "Small Samples Approach" for in-depth, case-based analysis in French-speaking Belgium
Abstract number: O249
Feron J.M., Legrand D., Tulkens P.M.
Background and Objectives: Belgium is a "high antibiotics prescribing" country in Europe for outpatients (Clin Infect Dis. 2007, 44:10915; 44:1259). This has triggered (i) the development of national guidelines for ambulatory practice using Evidence-Based Medicine data (supported by the official Belgian Antibiotic Policy Coordination Committee), and (ii) the sending to each general practitioner (GP) of an individual feed-back comparing her/his personal prescribing habits with an "average GP" in her/his region. We wanted to assess how these guidelines and feed-backs are perceived by GPs, and to determine how they are followed for respiratory tract infections (RTI).
Methods: SSA (in-depth analysis of actors' behaviour aiming to identify the rationale of a decision when faced with actual data) was used retrospectively on a cohort of patient contacts (n = 150) for antibiotic prescription for RTI. GPs (n = 38) were randomly selected and approached for data collection from medical records and direct interview (n = 30), to document medical history, reasons for encounter, symptoms, clinical examination, patient's demand, imaging or laboratory tests, diagnostic, prescribed antibiotic, and compliance with guidelines. Data were anonymously analysed in a double-blinded fashion by two independent researchers (both GPs) for assessment of guideline observance (antibiotic need and choice).
Results: Level of enrolment was 79%. Observance of guidelines (with CI 95%) as assessed by the GPs themselves was 41% (3349) [non-observance: 26% (1834); guidelines not know: 32% (2440)]. Inappropriateness of antibiotic prescription, as assessed by the independent researchers, was 56% (4864). Reasons for non-observance of guidelines (as expressed by the GP's; by order of frequency) were that guidelines are (i) too restrictive; (ii) unusable in everyday practice, (iii) not credible, (iv) only money-saving oriented, or (v) not known. Patients' expectations were judged as a major factor in the prescribing decision, overtaking the opinion of official scientific authorities.
Conclusions: Official guidelines and recommendations have only a limited impact on actual prescribing behaviour. Efforts to curb overprescription of antibiotics in RTI for community patients must aim at (i) decreasing patients' demands, and (ii) making guidelines more usable in everyday practice, independent of financial considerations, based on more credible sources, and with goals that the practitioner consider as being reachable.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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