Insight into antibiotic prescribing quality is key to general practitioners (GPs) to improve their prescribing behavior and to national antibiotic surveillance and stewardship programs. Additionally to numbers of prescribed antibiotics, quality indicators (QIs) linked to the clinical indication for prescribing are urgently needed. The aim of this proof of concept study was to define indication-linked QIs which can be easily implemented in Dutch primary care by collaborating with data-extraction/processing companies that routinely process patient data for GP practices. An expert group of academic and practicing GPs defined indication-linked QIs for which outcomes can be derived from routine care data. QI outcomes were calculated and fed back to GPs from 44 practices, associations between QI outcomes were determined, and GPs’ opinions and suggestions with respect to the new set were captured using an online questionnaire. The new set comprises: (1) total number of prescribed antibiotics per 1000 registered patients and percentages of generally non-1st choice antibiotics; (2) prescribing percentages for episodes of upper and lower respiratory tract infection; (3) 1st choice prescribing for episodes of tonsillitis, pneumonia and cystitis in women. Large inter-practice variation in QI outcomes was found. The validity of the QI outcomes was confirmed by associations that were expected. The new set was highly appreciated by GPs and additional QIs were suggested. We conclude that it proved feasible to provide GPs with informative, indication-linked feedback of their antibiotic prescribing quality by collaborating with established data extraction/processing companies. Based on GPs’ suggestions the set will be refined and extended and used in the near future as yearly feedback with benchmarking for GPs and for national surveillance and stewardship purposes.

中文翻译：

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通过适应症相关质量指标进行结构性抗生素监测和管理：荷兰初级保健的试点

深入了解抗生素处方质量是全科医生（GPs）改善其处方行为以及国家抗生素监测和管理计划的关键。除了处方抗生素的数量外，迫切需要与临床指征相关的质量指标（QIs）。这项概念验证研究的目的是通过与数据提取/处理公司合作来定义适应症相关的QI，这些QI可在荷兰的初级保健中轻松实施，该公司通常会按照GP惯例处理患者数据。由学术和实践中的全科医生组成的专家组定义了与适应症相关的QI，可以从常规护理数据中得出结果。计算了QI结果并从44种实践中反馈给GP，确定了QI结果之间的关联，并使用在线问卷收集了GP对新设置的意见和建议。新的数据包括：（1）每1000名注册患者的处方抗生素总数和一般非第一选择抗生素的百分比；（2）规定上呼吸道和下呼吸道感染发作的百分比；（3）规定妇女扁桃体炎，肺炎和膀胱炎发作的第一选择。发现QI结果之间存在较大的实践差异。QI结果的有效性已通过预期的关联得到确认。GP受到了新人的高度赞赏，并提出了其他QI。我们的结论是，向全科医生提供信息丰富，与已建立的数据提取/处理公司合作，对其抗生素处方质量进行适应症相关的反馈。根据GP的建议，该集合将得到完善和扩展，并在不久的将来用作年度反馈，并以此作为GP的基准以及用于国家监督和管理的基准。