Quality indicators for treatment of respiratory tract infections? An assessment by Danish general practitioners

Figures & data

Table I. The number of Danish GPs who agreed on the relevance of the quality indicators for upper respiratory tract infections as an assessment tool.^a

Quality indicators	Number of GPs^b n = 58
Patients with acute sinusitis:
Proportion treated with narrow-spectrum penicillin	48 (83)
Proportion treated with antibiotics	36 (62)
Proportion treated with broad-spectrum penicillin ± clavulanic acid	28 (48)
Proportion treated with macrolides	28 (48)
Proportion treated with cephalosporins	21 (36)
Proportion treated with quinolones	19 (33)
Patients with acute otitis media:
Proportion with discharging ear treated with antibiotics	50 (86)
Proportion treated with narrow-spectrum penicillin	48 (83)
Proportion of patients < 2 years treated with antibiotics	42 (72)
Proportion treated with antibiotics	37 (64)
Proportion treated with broad-spectrum penicillin ± clavulanic acid	36 (62)
Proportion of patients > 2 years with less than three days of symptoms of AOM with antibiotics	35 (60)
Proportion treated with macrolides	31 (53)
Proportion treated with cephalosporins	22 (38)
Proportion treated with quinolones	22 (38)
Patients with acute tonsillitis/pharyngitis:
Proportion with a positive StrepA test treated with antibiotics	53 (91)
Proportion treated with narrow-spectrum penicillin	50 (86)
Proportion treated with antibiotics	31 (53)
Proportion treated with broad-spectrum penicillin +/− clavulanic acid	25 (43)
Proportion treated with macrolides	25 (43)
Proportion treated with cephalosporins	22 (38)

AOM, acute otitis media; StrepA test, rapid Streptococcus A antigen detection test.

^aGPs who rated the quality indicator ≥ 3 on a four-point Likert scale.

^bData presented as n (%).

Table II. The number of Danish GPs who agreed on the relevance of the quality indicators for lower respiratory tract infections, respiratory tract infections in general and exacerbation of COPD as an assessment tool.^a..

Quality indicators	Number of GPs^b n = 58
Patients with acute bronchitis:
Proportion treated with antibiotics	35 (60)
Patients with pneumonia:
Proportion treated with narrow-spectrum penicillin	51 (88)
Proportion treated with broad-spectrum penicillin ± clavulanic acid	36 (62)
Proportion treated with macrolides	32 (55)
Proportion treated with quinolones	25 (43)
Proportion treated with cephalosporins	24 (41)
Patients with acute lower respiratory tract infections:
Proportion treated with narrow-spectrum penicillin	50 (86)
Proportion treated with antibiotics	36 (62)
Proportion treated with broad-spectrum penicillin ± clavulanic acid	33 (57)
Proportion with a CRP test < 20 mg/l treated with antibiotics	31 (53)
Proportion treated with macrolides	29 (50)
Proportion treated with quinolones	25 (43)
Proportion treated with cephalosporins	25 (43)
Patients with acute respiratory tract infections:
Proportion with no history of penicillin allergy treated with macrolides	31 (53)
Proportion treated with antibiotics	27 (47)
Patients with acute exacerbation of COPD:
Proportion treated with antibiotics	48 (83)
Proportion treated with broad-spectrum penicillin ± clavulanic acid	47 (81)
Proportion not fulfilling all the Anthonisen criteria^c treated with antibiotics	34 (59)
Proportion treated with macrolides	30 (52)
Proportion treated with quinolones	26 (45)

COPD, chronic obstructive pulmonary disease; CRP test, C-reactive protein rapid test.

^aGPs who rated the quality indicator ≥ 3 on a four-point Likert scale.

^bData presented as n (%).

^cIncreased dyspnoea, increasing expectorate and increasing purulence of expectorate.

Table III. Characteristics of the two groups of GPs in relation to their assessment of quality indicators for treatment of respiratory tract infections.

	GPs who agreed with > 50% of the quality indicators n = 33	GPs who agreed with ≤ 50% of the quality indicators n = 25
Females^a	48.5 (30.8–66.5)	36.0 (18.0–57.5)
Age in years^b	52.1 (49.2–55.0)	54.2 (50.8–57.6)
GPs working in a single-handed practice^a	42.4 (24.6–60.2)	40.0 (19.4–60.6)
Years working in a general practice^b	14.1 (10.4–17.8)	17.1 (13.3–20.9)
Working days per week^b	4.5 (4.3–4.8)	4.5 (4.3–4.8)
Working hours in the consultation per day^b	8.2 (7.8–8.5)	8.2 (8.0–8.4)
Consultations per day^b	25.1 (23.4–26.8)	25.7 (23.8–27.6)
Minutes per consultation^b	12.7 (11.8–13.5)	12.3 (11.3–13.3)
Home visits per week^b	2.7 (2.1–3.3)	3.4 (2.4–4.3)

Note: Two-sample tests of proportion for percentages and two-sample t-tests for means demonstrated no statistically significant differences of any of the characteristics between the two groups of GPs.

^aData presented as percentages (95% CI).

^bData presented as mean (95% CI).

Table IV. The distribution of antibiotics prescribed for respiratory tract infections by the two groups of GPs.^a

	Number of patients treated with antibiotics by GPs who agreed on > 50% of the quality indicators (n = 449)	Number of patients treated with antibiotics by GPs who agreed on ≤ 50% of the quality indicators (n = 328)
Narrow-spectrum penicillin	74.4 (70.1–78.4)	60.4 (54.8–65.7)
Broad-spectrum penicillin ± clavulanic acid	10.5 (7.8–13.7)	15.2 (11.5–19.6)
Macrolides	10.7 (8.0–13.9)	21.3 (17.0–26.2)
Others^b	4.5 (2.7–6.8)	3.0 (1.5–5.5)

Chi²-test (comparison of the distribution of antibiotics prescribed): P < 0.001.

^aData presented as percentages (95% CI).

^bOther antibiotics than penicillins or macrolides.