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Assessing Reduction of Antibiotic Prescribing for Acute, Non-Complicated Infections in Primary Care in Germany: Multi-Step Outcome Evaluation in the Cluster-Randomized Trial ARena

The three-armed cluster-randomized trial ARena (sustainable reduction of antibiotic-induced antimicrobial resistance) aimed to foster appropriate antibiotic use and reduce overprescribing in German ambulatory care to counter antibiotic resistance. Multi-faceted interventions targeted primary care ph...

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Autores principales: Poss-Doering, Regina, Kronsteiner, Dorothea, Kamradt, Martina, Kaufmann-Kolle, Petra, Andres, Edith, Wambach, Veit, Bleek, Julian, Wensing, Michel, Szecsenyi, Joachim
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8532997/
https://www.ncbi.nlm.nih.gov/pubmed/34680732
http://dx.doi.org/10.3390/antibiotics10101151
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author Poss-Doering, Regina
Kronsteiner, Dorothea
Kamradt, Martina
Kaufmann-Kolle, Petra
Andres, Edith
Wambach, Veit
Bleek, Julian
Wensing, Michel
Szecsenyi, Joachim
author_facet Poss-Doering, Regina
Kronsteiner, Dorothea
Kamradt, Martina
Kaufmann-Kolle, Petra
Andres, Edith
Wambach, Veit
Bleek, Julian
Wensing, Michel
Szecsenyi, Joachim
author_sort Poss-Doering, Regina
collection PubMed
description The three-armed cluster-randomized trial ARena (sustainable reduction of antibiotic-induced antimicrobial resistance) aimed to foster appropriate antibiotic use and reduce overprescribing in German ambulatory care to counter antibiotic resistance. Multi-faceted interventions targeted primary care physicians, teams and patients. This study examined the effectiveness of the implementation program. ARena was conducted in 14 primary care networks with 196 practices. All arms received data-based feedback on antibiotics prescribing and quality circles. Arms II and III received different add-on components each. Primary outcome examined is the prescribing rate for systemic antibiotics for cases with non-complicated acute infections (upper respiratory tract, bronchitis, sinusitis, tonsillitis, otitis media). Secondary outcomes refer to the prescribing of quinolones and guideline-recommended antibiotics. Based on pseudonymized quarterly claims data, mixed logistic regression models examined pre-post intervention antibiotic prescribing rate changes and compared to matched standard care. A significant rate reduction (arm I 11.7%; arm II 9.9%; arm III 12.7%) and significantly lower prescribing rates were observed for all arms (20.1%, 18.9% and 23.6%) compared to matched standard care (29.4%). Fluoroquinolone prescribing was reduced in all intervention arms and rates for recommended substances generally increased. No significant post-interventional difference between intervention arms was detected. Findings indicate implementation program impact compared to standard care.
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spelling pubmed-85329972021-10-23 Assessing Reduction of Antibiotic Prescribing for Acute, Non-Complicated Infections in Primary Care in Germany: Multi-Step Outcome Evaluation in the Cluster-Randomized Trial ARena Poss-Doering, Regina Kronsteiner, Dorothea Kamradt, Martina Kaufmann-Kolle, Petra Andres, Edith Wambach, Veit Bleek, Julian Wensing, Michel Szecsenyi, Joachim Antibiotics (Basel) Article The three-armed cluster-randomized trial ARena (sustainable reduction of antibiotic-induced antimicrobial resistance) aimed to foster appropriate antibiotic use and reduce overprescribing in German ambulatory care to counter antibiotic resistance. Multi-faceted interventions targeted primary care physicians, teams and patients. This study examined the effectiveness of the implementation program. ARena was conducted in 14 primary care networks with 196 practices. All arms received data-based feedback on antibiotics prescribing and quality circles. Arms II and III received different add-on components each. Primary outcome examined is the prescribing rate for systemic antibiotics for cases with non-complicated acute infections (upper respiratory tract, bronchitis, sinusitis, tonsillitis, otitis media). Secondary outcomes refer to the prescribing of quinolones and guideline-recommended antibiotics. Based on pseudonymized quarterly claims data, mixed logistic regression models examined pre-post intervention antibiotic prescribing rate changes and compared to matched standard care. A significant rate reduction (arm I 11.7%; arm II 9.9%; arm III 12.7%) and significantly lower prescribing rates were observed for all arms (20.1%, 18.9% and 23.6%) compared to matched standard care (29.4%). Fluoroquinolone prescribing was reduced in all intervention arms and rates for recommended substances generally increased. No significant post-interventional difference between intervention arms was detected. Findings indicate implementation program impact compared to standard care. MDPI 2021-09-24 /pmc/articles/PMC8532997/ /pubmed/34680732 http://dx.doi.org/10.3390/antibiotics10101151 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Poss-Doering, Regina
Kronsteiner, Dorothea
Kamradt, Martina
Kaufmann-Kolle, Petra
Andres, Edith
Wambach, Veit
Bleek, Julian
Wensing, Michel
Szecsenyi, Joachim
Assessing Reduction of Antibiotic Prescribing for Acute, Non-Complicated Infections in Primary Care in Germany: Multi-Step Outcome Evaluation in the Cluster-Randomized Trial ARena
title Assessing Reduction of Antibiotic Prescribing for Acute, Non-Complicated Infections in Primary Care in Germany: Multi-Step Outcome Evaluation in the Cluster-Randomized Trial ARena
title_full Assessing Reduction of Antibiotic Prescribing for Acute, Non-Complicated Infections in Primary Care in Germany: Multi-Step Outcome Evaluation in the Cluster-Randomized Trial ARena
title_fullStr Assessing Reduction of Antibiotic Prescribing for Acute, Non-Complicated Infections in Primary Care in Germany: Multi-Step Outcome Evaluation in the Cluster-Randomized Trial ARena
title_full_unstemmed Assessing Reduction of Antibiotic Prescribing for Acute, Non-Complicated Infections in Primary Care in Germany: Multi-Step Outcome Evaluation in the Cluster-Randomized Trial ARena
title_short Assessing Reduction of Antibiotic Prescribing for Acute, Non-Complicated Infections in Primary Care in Germany: Multi-Step Outcome Evaluation in the Cluster-Randomized Trial ARena
title_sort assessing reduction of antibiotic prescribing for acute, non-complicated infections in primary care in germany: multi-step outcome evaluation in the cluster-randomized trial arena
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8532997/
https://www.ncbi.nlm.nih.gov/pubmed/34680732
http://dx.doi.org/10.3390/antibiotics10101151
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