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)

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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

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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!