Effect of intervention promoting a reduction in antibiotic prescribing by improvement of diagnostic procedures: a prospective, before and after study in general practice

Objective To investigate if an intervention aimed at improving the quality of the diagnostic procedures in Spanish general practice could lower antibiotic prescribing in patients with respiratory tract infections (RTIs). Methods GPs in the intervention group (n=17) registered all patients with RTIs during a 3-week period before and after the intervention. The intervention was aimed at reducing prescribing of inappropriate antibiotics for RTIs by improving the diagnostic procedures and thereby helping the GPs to distinguish between bacterial and viral infections. It consisted of courses in management of RTI according to local clinical guidelines, and included implementation of two rapid diagnostic tests (StrepA and CRP measurement). Diagnoses and prescribing of antibiotics were assessed before and after the intervention, and compared to a control group not exposed to intervention (35 GPs). Results The intervention led to a significant reduction in antibiotic prescribing. Before the intervention 36% (29%-44%) of consultations were followed by antibiotic prescribing, after the intervention 24% (20%-29%). Antibiotic prescribing in the control group not exposed to intervention was 32% (27%-38%). The reduction was most pronounced in patients with sinusitis and lower RTIs. Quality improvement of diagnostic procedures may lead to a reduction of antibiotic prescribing in primary health care in Spain.