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BMJ Qual Saf 20:764-772 doi:10.1136/bmjqs.2010.049049
  • Original research

European Surveillance of Antimicrobial Consumption (ESAC): disease-specific quality indicators for outpatient antibiotic prescribing

  1. Herman Goossens1 on behalf of the ESAC Project Group
  1. 1University of Antwerp, Vaccine & Infectious Disease Institute (VAXINFECTIO), Laboratory of Medical Microbiology, Antwerp, Belgium
  2. 2University of Antwerp, Vaccine & Infectious Disease Institute (VAXINFECTIO), Centre for General Practice, Antwerp, Belgium
  3. 3University of Southampton, Community Clinical Sciences, School of Medicine, Southampton, UK
  4. 4UMC Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
  1. Correspondence to Dr Niels Adriaenssens, University of Antwerp—Campus Drie Eiken, Vaccine & Infectious Disease Institute (VAXINFECTIO), Centre for General Practice, Universiteitsplein 1, 2610 Antwerp, Belgium; niels.adriaenssens{at}ua.ac.be
  • Accepted 5 February 2011
  • Published Online First 21 March 2011

Abstract

Background In 2007, ESAC (http://www.esac.ua.ac.be) published a set of 12 valid drug-specific quality indicators for outpatient antibiotic use in Europe. In this study, the authors aimed to develop evidence-based disease-specific quality indicators for outpatient antibiotic prescribing in Europe.

Methods Two meetings were convened to produce a list of disease-specific quality indicators for outpatient antibiotic prescribing which conform to internationally agreed recommendations, building on a similar development of drug-specific quality indicators, and in collaboration with CHAMP and HAPPY AUDIT. 62 experts were asked to complete two scoring rounds of the proposed indicators on seven dimensions: their relevance to (1) reducing antimicrobial resistance, (2) patient health benefit, (3) cost-effectiveness, (4) policy makers, (5) individual prescribers, (6) their evidence base and (7) their range of acceptable use, using a scale ranging from 1 (=completely disagree) to 9 (=completely agree). Scores were judged according to the UCLA-RAND appropriateness method.

Results For the six main indications for antibiotic prescribing (acute otitis media, acute upper-respiratory infection, acute/chronic sinusitis, acute tonsillitis, acute bronchitis/bronchiolitis, cystitis/other urinary infection) and for pneumonia, three quality indicators were proposed, the percentage prescribed (a) antibiotics; (b) recommended antibiotics; (c) quinolones. This set was scored by 40 experts from 25 countries. After one scoring round, all indicators were already rated as relevant on all dimensions, except one.

Conclusion All proposed disease-specific quality indicators for outpatient antibiotic prescribing have face validity and are potentially applicable. They could be used to better describe antibiotic use and assess the quality of antibiotic prescribing patterns in ambulatory care.

Footnotes

  • NA and SC contributed equally.

  • Funding The ESAC project was funded by the European Centre for Disease Prevention and Control (ECDC; Grant Agreement 2007/001).

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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