Sustainable reduction of antibiotics-induced antimicrobial resistance (ARena) in German ambulatory care

Conditions

Non-complicated infections like upper respiratory tract infections, bronchitis, sinusitis, tonsillitis, and otitis media, and community acquired pneumonia and non-complicated cystitis Infections and Infestations

Kühn L, Kronsteiner D, Kaufmann-Kolle P, Andres E, Szecsenyi J, Wensing M, Poss-Doering R.

2022-09-19

10.1186/s12874-022-01725-3

Contextual factors influencing physicians’ perception of antibiotic prescribing in primary care in Germany — a prospective observational study

Annika Queder, Christine Arnold, Michel Wensing, Regina Poß-Doering

BMC Health Services Research2022-03-1213 citations

10.1186/s12913-022-07701-3

Promoting rational antibiotic prescribing for non-complicated infections: understanding social influence in primary care networks in Germany

Regina Poß-Doering, Martina Kamradt, Katharina Glassen, Edith Andres, Petra Kaufmann‐Kolle et al. (6 authors)

BMC Family Practice2020-03-1420 citations

10.1186/s12875-020-01119-8

The complex phenomenon of dysrational antibiotics prescribing decisions in German primary healthcare: a qualitative interview study using dual process theory

Regina Poß-Doering, Martina Kamradt, Anna Stuermlinger, Katharina Glassen, Petra Kaufmann‐Kolle et al. (7 authors)

Antimicrobial Resistance and Infection Control2020-01-0628 citations

10.1186/s13756-019-0664-6

Sustainable reduction of antibiotic-induced antimicrobial resistance (ARena) in German ambulatory care: study protocol of a cluster randomised trial.

Kamradt M, Kaufmann-Kolle P, Andres E, Brand T, Klingenberg A, Glassen K, Poß-Doering R, Uhlmann L, Hees K, Weber D, Gutscher A, Wambach V, Szecsenyi J, Wensing M.

2018-02-0513 citations

10.1186/s13012-018-0722-0

Interventions

Non-blinded cluster randomized trial with three arms and an added cohort that reflects usual care in 14 practice networks in two German federal states (Bavaria and North Rhine-Westphalia) with an addi

Eligibility

Sex/Gender

All

Inclusion criteria

Inclusion criteria: 1. Healthcare professionals need to be part of one of the 14 participating practice networks in Bavaria and North Rhine-Westphalia and belong to one of the following medical specialist groups (Facharztgruppen, FG): GPs (Allgemeinmediziner, Hausarzt, hausätzlich tätiger Internist: FG 01, 02, 03), internists (Internist: FG 23), gynaecologists (Gynäkologe: FG 15, 18), ENT physicans (HNO-Arzt: FG 19), urologists (Urologe: FG 67), respiratory physicians (Pneumologe: FG 30,39,45), and paediatricians (Kinderarzt: FG 34, 40, 46) 2. Patients aged over 18, diagnosed with upper respiratory tract infections, acute bronchitis, sinusitis, tonsillitis, otitis media, non-complicated cystitis, or community acquired pneumonia by physicians in participating ambulatory practices and registered at AOK health insurance in Bavaria or North Rhine-Westphalia, Germany

Exclusion criteria

Exclusion criteria: Participants younger than 18 years and without German language skills will be excluded from survey and interviews

Design outcomes

Primary

Measure	Time frame
Antibiotics prescription rate in patients with non-complicated acute infections (upper respiratory tract infections, bronchitis, sinusitis, tonsillitis, and otitis media) within the three intervention arms, extracted from pseudonymized claims data each quarter year	—

Secondary

Measure	Time frame
Extracted from pseudonymized claims data each quarter year: 1. Use of antibiotics in ambulatory care in defined daily dose (DDD) per 1000 residents (respectively insured persons) per day and region 2. % of defined daily dose (DDD) of (a) broad-spectrum quinolones of all used antibiotics and (b) broad-spectrum cephalosporins (3rd and 4th generation) of all used antibiotics 3. % of patients (18-75 years) with acute bronchitis, patients (> 18 years) with sinusitis, patients (> 2 years) with otitis media and patients (> 1 year) with upper respiratory tract infections/tonsillitis with a prescription of (a) recommended antibiotics, if necessary at all, but (b) less broad-spectrum antibiotics like quinolones 4. % of women (> 18 years) with a diagnosis of non-complicated cystitis and a prescription of (a) antibiotics, (b) recommended antibiotics but (c) less broad-spectrum antibiotics like quinolones 5. % of patients (18-65 years) with community acquired pneumonia and a prescription of (a) antibiotics, (b) recommended antibiotics, (c) less broad-spectrum antibiotics like quinolones and (d) less broad-spectrum antibiotics like cephalosporins or macrolides 6. % of patients with non-complicated infections who use medical emergency service 7. % of patients with community-acquired pneumonia and hospitalization The process evaluation covers (a) the uptake and perceived impact of intervention components by participants with a focus on handling patients with non-complicated infections, (b) the perceived impact of contextual factors, particularly those related to practice networks, and (c) perceptions of patients’ expectations regarding antibiotics prescribing.	—

Measure

Time frame

Extracted from pseudonymized claims data each quarter year: 1. Use of antibiotics in ambulatory care in defined daily dose (DDD) per 1000 residents (respectively insured persons) per day and region 2. % of defined daily dose (DDD) of (a) broad-spectrum quinolones of all used antibiotics and (b) broad-spectrum cephalosporins (3rd and 4th generation) of all used antibiotics 3. % of patients (18-75 years) with acute bronchitis, patients (> 18 years) with sinusitis, patients (> 2 years) with otitis media and patients (> 1 year) with upper respiratory tract infections/tonsillitis with a prescription of (a) recommended antibiotics, if necessary at all, but (b) less broad-spectrum antibiotics like quinolones 4. % of women (> 18 years) with a diagnosis of non-complicated cystitis and a prescription of (a) antibiotics, (b) recommended antibiotics but (c) less broad-spectrum antibiotics like quinolones 5. % of patients (18-65 years) with community acquired pneumonia and a prescription of (a) antibiotics, (b) recommended antibiotics, (c) less broad-spectrum antibiotics like quinolones and (d) less broad-spectrum antibiotics like cephalosporins or macrolides 6. % of patients with non-complicated infections who use medical emergency service 7. % of patients with community-acquired pneumonia and hospitalization The process evaluation covers (a) the uptake and perceived impact of intervention components by participants with a focus on handling patients with non-complicated infections, (b) the perceived impact of contextual factors, particularly those related to practice networks, and (c) perceptions of patients’ expectations regarding antibiotics prescribing.

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Countries

Germany

Outcome results

None listed