Medical audit changes physicians' prescribing of antibiotics for respiratory tract infections

Abstract

Objective - To reduce the prescribing of antibiotics in respiratory tract infections (RTI). Design and subjects - The Audit Odense model for registration and quality development was used for RTI. Twenty general practitioners registered their consultations for RTIs during 4 weeks in February-March (n=1124) and November-December (n=926) in 1995. Diagnosis, choice of antibiotics and diagnostic tools were registered. In between the two registrations an active intervention took place. Consultations for RTIs among 25 physicians (who had not participated in any intervention or follow-up discussion) served as a control. Setting - General practice in southern Sweden. Outcome measures - Prescribing of antibiotics before and after an intervention. Results - The proportion of patients not receiving an antibiotic increased from the first to the second registration in both groups, in the intervention group from 45 to 55% (p<0.001) and in the control group from 36 to 40% (p=0.0298). The reduction was most evident in patients diagnosed with tonsillitis and bronchitis. This was in concordance with an increase in the use of desktop diagnostics (Strep A and CRP). Conclusion - These results indicate that it is possible to achieve a change in the utilisation of antibiotics in the treatment of RTIs and that the Audit Project Odense (APO) model could be a valuable tool.