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3. Clinical diagnosis of SARS-CoV-2 infection: An observational study of respiratory tract infection in primary care in the early phase of the pandemic

Author

van der Velden, Alike W., primary, Shanyinde, Milensu, additional, Bongard, Emily, additional, Böhmer, Femke, additional, Chlabicz, Slawomir, additional, Colliers, Annelies, additional, García-Sangenís, Ana, additional, Malania, Lile, additional, Pauer, Jozsef, additional, Tomacinschii, Angela, additional, Yu, Ly-Mee, additional, Loens, Katherine, additional, Ieven, Margareta, additional, Verheij, Theo J., additional, Goossens, Herman, additional, Vellinga, Akke, additional, and Butler, Christopher C., additional

Published
2023
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4. The experiences of patients ill with COVID-19-like symptoms and the role of testing for SARS-CoV-2 in supporting them: A qualitative study in eight European countries during the first wave of the pandemic.

Author

Hoste, Melanie E., Wanat, Marta, Gobat, Nina, Anastasaki, Marilena, Böhmer, Femke, Chlabicz, Sławomir, Colliers, Annelies, Farrell, Karen, Karkana, Maria-Nefeli, Kinsman, John, Lionis, Christos, Marcinowicz, Ludmila, Reinhardt, Katrin, Skoglund, Ingmarie, Sundvall, Pär-Daniel, Vellinga, Akke, Goossens, Herman, Butler, Christopher C., van der Velden, Alike, and Tonkin-Crine, Sarah

Published
2023
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5. Disease-Specific Quality Indicators for Outpatient Antibiotic Prescribing for Respiratory Infections (ESAC Quality Indicators) Applied to Point Prevalence Audit Surveys in General Practices in 13 European Countries

Author

Vellinga, Akke, Luke-Currier, Addiena, Garzón-Orjuela, Nathaly, Aabenhus, Rune, Anastasaki, Marilena, Balan, Anca, Böhmer, Femke, Lang, Valerija Bralić, Chlabicz, Slawomir, Coenen, Samuel, García-Sangenís, Ana, Kowalczyk, Anna, Malania, Lile, Tomacinschii, Angela, van der Linde, Sanne R., Bongard, Emily, Butler, Christopher C., Goossens, Herman, van der Velden, Alike W., Vellinga, Akke, Luke-Currier, Addiena, Garzón-Orjuela, Nathaly, Aabenhus, Rune, Anastasaki, Marilena, Balan, Anca, Böhmer, Femke, Lang, Valerija Bralić, Chlabicz, Slawomir, Coenen, Samuel, García-Sangenís, Ana, Kowalczyk, Anna, Malania, Lile, Tomacinschii, Angela, van der Linde, Sanne R., Bongard, Emily, Butler, Christopher C., Goossens, Herman, and van der Velden, Alike W.

Abstract

Up to 80% of antibiotics are prescribed in the community. An assessment of prescribing by indication will help to identify areas where improvement can be made. A point prevalence audit study (PPAS) of consecutive respiratory tract infection (RTI) consultations in general practices in 13 European countries was conducted in January–February 2020 (PPAS-1) and again in 2022 (PPAS-4). The European Surveillance of Antibiotic Consumption quality indicators (ESAC-QI) were calculated to identify where improvements can be made. A total of 3618 consultations were recorded for PPAS-1 and 2655 in PPAS-4. Bacterial aetiology was suspected in 26% (PPAS-1) and 12% (PPAS-4), and an antibiotic was prescribed in 30% (PPAS-1) and 16% (PPAS-4) of consultations. The percentage of adult patients with bronchitis who receive an antibiotic should, according to the ESAC-QI, not exceed 30%, which was not met by participating practices in any country except Denmark and Spain. For patients (≥1) with acute upper RTI, less than 20% should be prescribed an antibiotic, which was achieved by general practices in most countries, except Ireland (both PPAS), Croatia (PPAS-1), and Greece (PPAS-4) where prescribing for acute or chronic sinusitis (0–20%) was also exceeded. For pneumonia in adults, prescribing is acceptable for 90–100%, and this is lower in most countries. Prescribing for tonsillitis (≥1) exceeded the ESAC-QI (0–20%) in all countries and was 69% (PPAS-1) and 75% (PPAS-4). In conclusion, ESAC-QI applied to PPAS outcomes allows us to evaluate appropriate antibiotic prescribing by indication and benchmark general practices and countries., Up to 80% of antibiotics are prescribed in the community. An assessment of prescribing by indication will help to identify areas where improvement can be made. A point prevalence audit study (PPAS) of consecutive respiratory tract infection (RTI) consultations in general practices in 13 European countries was conducted in January–February 2020 (PPAS-1) and again in 2022 (PPAS-4). The European Surveillance of Antibiotic Consumption quality indicators (ESAC-QI) were calculated to identify where improvements can be made. A total of 3618 consultations were recorded for PPAS-1 and 2655 in PPAS-4. Bacterial aetiology was suspected in 26% (PPAS-1) and 12% (PPAS-4), and an antibiotic was prescribed in 30% (PPAS-1) and 16% (PPAS-4) of consultations. The percentage of adult patients with bronchitis who receive an antibiotic should, according to the ESAC-QI, not exceed 30%, which was not met by participating practices in any country except Denmark and Spain. For patients (≥1) with acute upper RTI, less than 20% should be prescribed an antibiotic, which was achieved by general practices in most countries, except Ireland (both PPAS), Croatia (PPAS-1), and Greece (PPAS-4) where prescribing for acute or chronic sinusitis (0–20%) was also exceeded. For pneumonia in adults, prescribing is acceptable for 90–100%, and this is lower in most countries. Prescribing for tonsillitis (≥1) exceeded the ESAC-QI (0–20%) in all countries and was 69% (PPAS-1) and 75% (PPAS-4). In conclusion, ESAC-QI applied to PPAS outcomes allows us to evaluate appropriate antibiotic prescribing by indication and benchmark general practices and countries.

Published
2023

6. Clinical diagnosis of SARS-CoV-2 infection: An observational study of respiratory tract infection in primary care in the early phase of the pandemic

Author

HAG Infectieziekten, JC onderzoeksprogramma Infectieziekten, Infection & Immunity, Ecraid, van der Velden, Alike W, Shanyinde, Milensu, Bongard, Emily, Böhmer, Femke, Chlabicz, Slawomir, Colliers, Annelies, García-Sangenís, Ana, Malania, Lile, Pauer, Jozsef, Tomacinschii, Angela, Yu, Ly-Mee, Loens, Katherine, Ieven, Margareta, Verheij, Theo J, Goossens, Herman, Vellinga, Akke, Butler, Christopher C, HAG Infectieziekten, JC onderzoeksprogramma Infectieziekten, Infection & Immunity, Ecraid, van der Velden, Alike W, Shanyinde, Milensu, Bongard, Emily, Böhmer, Femke, Chlabicz, Slawomir, Colliers, Annelies, García-Sangenís, Ana, Malania, Lile, Pauer, Jozsef, Tomacinschii, Angela, Yu, Ly-Mee, Loens, Katherine, Ieven, Margareta, Verheij, Theo J, Goossens, Herman, Vellinga, Akke, and Butler, Christopher C

Published
2023

7. The experiences of patients ill with COVID-19-like symptoms and the role of testing for SARS-CoV-2 in supporting them: A qualitative study in eight European countries during the first wave of the pandemic

Author

HAG Infectieziekten, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, Hoste, Melanie E, Wanat, Marta, Gobat, Nina, Anastasaki, Marilena, Böhmer, Femke, Chlabicz, Sławomir, Colliers, Annelies, Farrell, Karen, Karkana, Maria-Nefeli, Kinsman, John, Lionis, Christos, Marcinowicz, Ludmila, Reinhardt, Katrin, Skoglund, Ingmarie, Sundvall, Pär-Daniel, Vellinga, Akke, Goossens, Herman, Butler, Christopher C, van der Velden, Alike, Tonkin-Crine, Sarah, Anthierens, Sibyl, HAG Infectieziekten, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, Hoste, Melanie E, Wanat, Marta, Gobat, Nina, Anastasaki, Marilena, Böhmer, Femke, Chlabicz, Sławomir, Colliers, Annelies, Farrell, Karen, Karkana, Maria-Nefeli, Kinsman, John, Lionis, Christos, Marcinowicz, Ludmila, Reinhardt, Katrin, Skoglund, Ingmarie, Sundvall, Pär-Daniel, Vellinga, Akke, Goossens, Herman, Butler, Christopher C, van der Velden, Alike, Tonkin-Crine, Sarah, and Anthierens, Sibyl

Published
2023

8. Disease-Specific Quality Indicators for Outpatient Antibiotic Prescribing for Respiratory Infections (ESAC Quality Indicators) Applied to Point Prevalence Audit Surveys in General Practices in 13 European Countries

Author

HAG Infectieziekten, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, Vellinga, Akke, Luke-Currier, Addiena, Garzón-Orjuela, Nathaly, Aabenhus, Rune, Anastasaki, Marilena, Balan, Anca, Böhmer, Femke, Lang, Valerija Bralić, Chlabicz, Slawomir, Coenen, Samuel, García-Sangenís, Ana, Kowalczyk, Anna, Malania, Lile, Tomacinschii, Angela, van der Linde, Sanne R, Bongard, Emily, Butler, Christopher C, Goossens, Herman, van der Velden, Alike W, HAG Infectieziekten, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, Vellinga, Akke, Luke-Currier, Addiena, Garzón-Orjuela, Nathaly, Aabenhus, Rune, Anastasaki, Marilena, Balan, Anca, Böhmer, Femke, Lang, Valerija Bralić, Chlabicz, Slawomir, Coenen, Samuel, García-Sangenís, Ana, Kowalczyk, Anna, Malania, Lile, Tomacinschii, Angela, van der Linde, Sanne R, Bongard, Emily, Butler, Christopher C, Goossens, Herman, and van der Velden, Alike W

Published
2023

10. Contributors

Author

Akova, Murat, primary, Altiner, Attila, additional, Andrašević, Arjana T., additional, Azap, Ozlem K., additional, Bavestrello, Luis, additional, Beović, Bojana, additional, Böhmer, Femke, additional, Béraud, Guillaume, additional, Buising, Kirsty, additional, Can, Füsun, additional, Castro, José L., additional, Čižman, Milan, additional, Cosgrove, Sara E., additional, Cotta, Menino O., additional, de Kraker, Marlieke E.A., additional, de With, Katja, additional, De Waele, Jan, additional, Dyar, Oliver J., additional, Ergönül, Önder, additional, Erntell, Mats, additional, Ghafur, Abdul, additional, Gyssens, Inge C., additional, Harbarth, Stephan, additional, Hedin, Katarina, additional, Hernández-Gómez, Cristhian, additional, Howard, Philip, additional, Hulscher, Marlies E.J.L., additional, Karatuna, Onur, additional, Kern, Winfried V., additional, Keuleyan, Emma, additional, Kofteridis, Diamantis P., additional, Kostyanev, Tomislav, additional, Lacor, Patrick, additional, Levy-Hara, Gabriel, additional, Li, David X., additional, Markou, Theodore I., additional, Mendelson, Marc, additional, Messiaen, Peter, additional, Nathwani, Dilip, additional, Pagani, Leonardo, additional, Paño Pardo, José R., additional, Pluss-Suard, Catherine, additional, Prins, Jan, additional, Pulcini, Céline, additional, Ramón-Pardo, Pilar, additional, Roberts, Jason A., additional, Rodríguez-Baño, Jesús, additional, Schouten, Jeroen, additional, Schwaber, Mitchell J., additional, Senn, Laurence, additional, Shibayama, Keigo, additional, Sinnollareddy, Mahipal G., additional, Sneddon, Jacqueline, additional, Lundborg, Cecilia Stålsby, additional, Tacconelli, Evelina, additional, Thursky, Karin, additional, Valachis, Antonis, additional, Viale, Pierluigi, additional, Villegas, María V., additional, Vlahović-Palčevski, Vera, additional, Wechsler-Fördös, Agnes, additional, Wollny, Anja, additional, and Zanetti, Giorgio, additional

Published
2017
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12. Point-of care testing, antibiotic prescribing, and prescribing confidence for respiratory tract infections in primary care:a prospective audit in 18 European countries

Author

van der Velden, Alike W., van de Pol, Alma C., Bongard, Emily, Cianci, Daniela, Aabenhus, Rune, Balan, Anca, Böhmer, Femke, Lang, Valerija Bralić, Bruno, Pascale, Chlabicz, Slawomir, Coenen, Samuel, Colliers, Annelies, García-Sangenís, Ana, Ghazaryan, Hrachuhi, Godycki-Ćwirko, Maciej, Jensen, Siri, Lionis, Christos, van der Linde, Sanne R., Malania, Lile, Pauer, Jozsef, Tomacinschii, Angela, Vellinga, Akke, Zastavnyy, Ihor, Emmerich, Susanne, Zerda, Adam, Verheij, Theo J., Goossens, Herman, Butler, Christopher C., van der Velden, Alike W., van de Pol, Alma C., Bongard, Emily, Cianci, Daniela, Aabenhus, Rune, Balan, Anca, Böhmer, Femke, Lang, Valerija Bralić, Bruno, Pascale, Chlabicz, Slawomir, Coenen, Samuel, Colliers, Annelies, García-Sangenís, Ana, Ghazaryan, Hrachuhi, Godycki-Ćwirko, Maciej, Jensen, Siri, Lionis, Christos, van der Linde, Sanne R., Malania, Lile, Pauer, Jozsef, Tomacinschii, Angela, Vellinga, Akke, Zastavnyy, Ihor, Emmerich, Susanne, Zerda, Adam, Verheij, Theo J., Goossens, Herman, and Butler, Christopher C.

Abstract

Background: Between-country differences have been described in antibiotic prescribing for respiratory tract infection (RTI) in primary care, but not yet for diagnostic testing procedures and prescribing confidence. Aim: To describe between-country differences in RTI management, particularly diagnostic testing and antibiotic prescribing, and investigate which factors relate to antibiotic prescribing and GPs’ prescribing confidence. Design & setting: Prospective audit in 18 European countries. Method: An audit of GP-registered patient, clinical, and management characteristics for patients presenting with sore throat and/or lower RTI (n = 4982), and GPs' confidence in their antibiotic prescribing decision. Factors related to antibiotic prescribing and confidence were analysed using multi-level logistic regression. Results: Antibiotic prescribing proportions varied considerably: <20% in four countries, and >40% in six countries. There was also considerable variation in point-of care (POC) testing (0% in Croatia, Moldova, and Romania, and >65% in Denmark and Norway, mainly for C-reactive protein [CRP] and group A streptococcal [strep A] infection), and in laboratory or hospital-based testing (<3% in Hungary, the Netherlands, and Spain, and >30% in Croatia, Georgia, Greece, and Moldova, mainly chest X-ray and white blood cell counting). Antibiotic prescribing was related to illness severity, comorbidity, age, fever, and country, but not to having performed a POC test. In nearly 90% of consultations, GPs were confident in their antibiotic prescribing decision. Conclusion: Despite high confidence in decisions about antibiotic prescribing, there is considerable variation in the primary care of RTI in European countries, with GPs prescribing antibiotics overall more often than is considered appropriate. POC testing may enhance the quality of antibiotic prescribing decisions if it can safely reverse decisions confidently made on clinical grounds alone to

Published
2022

13. Patients' and clinicians' perspectives on the primary care consultations for acute respiratory infections during the first wave of the COVID-19 pandemic: an eight-country qualitative study in Europe

Author

HAG Infectieziekten, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, Wanat, Marta, Hoste, Melanie Eugenie, Gobat, Nina Helene, Anastasaki, Marilena, Böhmer, Femke, Chlabicz, Slawomir, Colliers, Annelies, Farrell, Karen, Hollerbach, Sophie, Karkana, Maria-Nefeli, Kinsman, John, Lionis, Christos, Marcinowicz, Ludmila, Reinhardt, Katrin, Skoglund, Ingmarie, Sundvall, Pär-Daniel, Vellinga, Akke, Goossens, Herman, Butler, Christopher, van der Velden, Alike, Anthierens, Sibyl, Tonkin-Crine, Sarah, HAG Infectieziekten, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, Wanat, Marta, Hoste, Melanie Eugenie, Gobat, Nina Helene, Anastasaki, Marilena, Böhmer, Femke, Chlabicz, Slawomir, Colliers, Annelies, Farrell, Karen, Hollerbach, Sophie, Karkana, Maria-Nefeli, Kinsman, John, Lionis, Christos, Marcinowicz, Ludmila, Reinhardt, Katrin, Skoglund, Ingmarie, Sundvall, Pär-Daniel, Vellinga, Akke, Goossens, Herman, Butler, Christopher, van der Velden, Alike, Anthierens, Sibyl, and Tonkin-Crine, Sarah

Published
2022

14. Point of care testing, antibiotic prescribing and prescribing confidence for respiratory tract infections in primary care: a prospective audit in 18 European countries

Author

HAG Infectieziekten, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, Huisartsopleiding, Biostatistiek Onderzoek, van der Velden, Alike, van de Pol, Alma C, Bongard, Emily, Cianci, Daniela, Aabenhus, Rune, Balan, Anca, Böhmer, Femke, Bralic Lang, Valerija, Bruno, Pascale, Chlabicz, Slawomir, Coenen, Samuel, Colliers, Annelies, Garcia-Sangenis, Anna, Ghazaryan, Hrachuhi, Godycki-Cwirko, Maciek, Jensen, Siri, Lionis, Christos, van der Linde, Sanne R, Malania, Lile, Pauer, Jozsef, Tomacinschii, Angela, Vellinga, Akke, Zastavnyy, Ihor, Emmerich, Susanne, Zerda, Adam, Verheij, Theo J, Goossens, Herman, Butler, Christopher C, HAG Infectieziekten, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, Huisartsopleiding, Biostatistiek Onderzoek, van der Velden, Alike, van de Pol, Alma C, Bongard, Emily, Cianci, Daniela, Aabenhus, Rune, Balan, Anca, Böhmer, Femke, Bralic Lang, Valerija, Bruno, Pascale, Chlabicz, Slawomir, Coenen, Samuel, Colliers, Annelies, Garcia-Sangenis, Anna, Ghazaryan, Hrachuhi, Godycki-Cwirko, Maciek, Jensen, Siri, Lionis, Christos, van der Linde, Sanne R, Malania, Lile, Pauer, Jozsef, Tomacinschii, Angela, Vellinga, Akke, Zastavnyy, Ihor, Emmerich, Susanne, Zerda, Adam, Verheij, Theo J, Goossens, Herman, and Butler, Christopher C

Published
2022

15. Antibiotics and uncertainty of diagnosis in viral respiratory infections: Point‐prevalence survey across 15 European countries.

Author

Khosravi, Leila, Imort, Dominic, Gijon Mediavilla, Manuel, Ahmed, Leila, Früh, Emanuela, Renk, Hanna, Nyirenda Nyang'wa, Maggie, Sritharan, Ratha, Bongard, Emily, Aabenhus, Rune, Balan, Anca, Böhmer, Femke, Chlabicz, Slawomir, Coenen, Samuel, García‐Sangenís, Ana, Ghazaryan, Hrachuhi, Lionis, Christos, van der Linde, Sanne, Malania, Lile, and Pauer, Jozsef

Subjects
VIRUS diseases, RESPIRATORY infections, DIAGNOSIS
Abstract

Certainty of the care provider regarding this aetiology was higher in EDs (82% high certainty compared to 76% in primary care, I p i = 0.014). Accordingly, oxygen saturation was measured in 88% of ED patients but only in 39% of primary care patients. Antibiotics for lower respiratory tract infection in children presenting in primary care in England (ARTIC PC): a double-blind, randomised, placebo-controlled trial. [Extracted from the article]

Published
2023
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16. Patients’ and clinicians’ perspectives on the primary care consultations for acute respiratory infections during the first wave of the COVID-19 pandemic: an eight-country qualitative study in Europe

Author

Wanat, Marta, primary, Hoste, Melanie Eugenie, additional, Gobat, Nina Helene, additional, Anastasaki, Marilena, additional, Böhmer, Femke, additional, Chlabicz, Slawomir, additional, Colliers, Annelies, additional, Farrell, Karen, additional, Hollerbach, Sophie, additional, Karkana, Maria-Nefeli, additional, Kinsman, John, additional, Lionis, Christos, additional, Marcinowicz, Ludmila, additional, Reinhardt, Katrin, additional, Skoglund, Ingmarie, additional, Sundvall, Pär-Daniel, additional, Vellinga, Akke, additional, Goossens, Herman, additional, Butler, Christopher C, additional, van der Velden, Alike, additional, Anthierens, Sibyl, additional, and Tonkin-Crine, Sarah, additional

Published
2022
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17. Point-of-care testing, antibiotic prescribing, and prescribing confidence for respiratory tract infections in primary care: a prospective audit in 18 European countries

Author

van der Velden, Alike W, primary, van de Pol, Alma C, additional, Bongard, Emily, additional, Cianci, Daniela, additional, Aabenhus, Rune, additional, Balan, Anca, additional, Böhmer, Femke, additional, Bralić Lang, Valerija, additional, Bruno, Pascale, additional, Chlabicz, Slawomir, additional, Coenen, Samuel, additional, Colliers, Annelies, additional, García-Sangenís, Ana, additional, Ghazaryan, Hrachuhi, additional, Godycki-Ćwirko, Maciej, additional, Jensen, Siri, additional, Lionis, Christos, additional, van der Linde, Sanne R, additional, Malania, Lile, additional, Pauer, Jozsef, additional, Tomacinschii, Angela, additional, Vellinga, Akke, additional, Zastavnyy, Ihor, additional, Emmerich, Susanne, additional, Zerda, Adam, additional, Verheij, Theo J, additional, Goossens, Herman, additional, and Butler, Christopher C, additional

Published
2021
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18. Factors, Perceptions and Beliefs Associated with Inappropriate Antibiotic Prescribing in German Primary Dental Care: A Qualitative Study

Author

Böhmer, Femke, Hornung, Anne, Burmeister, Ulrike, Köchling, Anna, Altiner, Attila, Lang, Hermann, and Löffler, Christin

Subjects
anti-bacterial agents, dentistry, inappropriate prescribing, Therapeutics. Pharmacology, RM1-950, antimicrobial resistance, Article, qualitative research
Abstract

Dentists account for up to 10% of all prescribed antibiotics in primary care, with up to 80% being inappropriate. Targeted approaches to change prescription behavior are scarce. This study aimed at identifying specific barriers and facilitators for prudent antibiotic use in German dentistry by using qualitative methods. Nine in-depth interviews and two focus group discussions with another nine dentists were conducted and analyzed thematically. Dentists described being conflicted by the discordance of available treatment time and the necessity of thorough therapy. Lacking the opportunity of follow-up led to uncertainty. Dentists felt a lack of medical competency concerning prophylaxis for infectious endocarditis. A lack of empowerment to make therapeutic decisions interfered with guideline-conformity. The communication with fellow physicians is conflictual and improvement was wished for. In consequence, dentists felt pressure by potential medico-legal liability. Patients demanding quick and easy pain relief put extra strain on the interviewed dentists. Our hypotheses concord with preliminary data, mainly from the UK, but highlighted specifically medico-legal concerns and interprofessional communication as even greater barriers as described before. Tailored interventional concepts based on our findings may have the potential to lower antibiotic prescriptions in German primary dental care.

Published
2021

19. Supporting Primary Care Professionals to Stay in Work During the COVID-19 Pandemic: Views on Personal Risk and Access to Testing During the First Wave of Pandemic in Europe

Author

Wanat, Marta, primary, Hoste, Melanie, additional, Gobat, Nina, additional, Anastasaki, Marilena, additional, Böhmer, Femke, additional, Chlabicz, Slawomir, additional, Colliers, Annelies, additional, Farrell, Karen, additional, Karkana, Maria-Nefeli, additional, Kinsman, John, additional, Lionis, Christos, additional, Marcinowicz, Ludmila, additional, Reinhardt, Katrin, additional, Skoglund, Ingmarie, additional, Sundvall, Pär-Daniel, additional, Vellinga, Akke, additional, Goossens, Herman, additional, Butler, Christopher C., additional, Velden, Alike van der, additional, Anthierens, Sibyl, additional, and Tonkin-Crine, Sarah, additional

Published
2021
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20. Primary care for patients with respiratory tract infection before and early on in the COVID-19 pandemic: an observational study in 16 European countries

Author

van der Velden, Alike W, primary, Bax, Eva A, additional, Bongard, Emily, additional, Munck Aabenhus, Rune, additional, Anastasaki, Marilena, additional, Anthierens, Sibyl, additional, Balan, Anca, additional, Böhmer, Femke, additional, Bruno, Pascale, additional, Chlabicz, Slawomir, additional, Coenen, Samuel, additional, Colliers, Annelies, additional, Emmerich, Susanne, additional, Garcia-Sangenis, Ana, additional, Ghazaryan, Hrachuhi, additional, van der Linde, Sanne R, additional, Malania, Lile, additional, Pauer, József, additional, Tomacinschii, Angela, additional, Tonkin-Crine, Sarah, additional, Vellinga, Akke, additional, Zastavnyy, Ihor, additional, Verheij, Theo, additional, Goossens, Herman, additional, and Butler, Christopher C, additional

Published
2021
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21. Transformation of primary care during the COVID-19 pandemic: experiences of healthcare professionals in eight European countries

Author

Wanat, Marta, primary, Hoste, Melanie, additional, Gobat, Nina, additional, Anastasaki, Marilena, additional, Böhmer, Femke, additional, Chlabicz, Slawomir, additional, Colliers, Annelies, additional, Farrell, Karen, additional, Karkana, Maria-Nefeli, additional, Kinsman, John, additional, Lionis, Christos, additional, Marcinowicz, Ludmila, additional, Reinhardt, Katrin, additional, Skoglund, Ingmarie, additional, Sundvall, Pär-Daniel, additional, Vellinga, Akke, additional, Verheij, Theo JM, additional, Goossens, Herman, additional, Butler, Christopher C, additional, van der Velden, Alike, additional, Anthierens, Sibyl, additional, and Tonkin-Crine, Sarah, additional

Published
2021
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22. Supporting Primary Care Professionals to Stay in Work During the COVID-19 Pandemic: Views on Personal Risk and Access to Testing During the First Wave of Pandemic in Europe

Author

HAG Infectieziekten, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, Wanat, Marta, Hoste, Melanie, Gobat, Nina, Anastasaki, Marilena, Böhmer, Femke, Chlabicz, Slawomir, Colliers, Annelies, Farrell, Karen, Karkana, Maria-Nefeli, Kinsman, John, Lionis, Christos, Marcinowicz, Ludmila, Reinhardt, Katrin, Skoglund, Ingmarie, Sundvall, Pär-Daniel, Vellinga, Akke, Goossens, Herman, Butler, Christopher C, van der Velden, Alike, Anthierens, Sibyl, Tonkin-Crine, Sarah, HAG Infectieziekten, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, Wanat, Marta, Hoste, Melanie, Gobat, Nina, Anastasaki, Marilena, Böhmer, Femke, Chlabicz, Slawomir, Colliers, Annelies, Farrell, Karen, Karkana, Maria-Nefeli, Kinsman, John, Lionis, Christos, Marcinowicz, Ludmila, Reinhardt, Katrin, Skoglund, Ingmarie, Sundvall, Pär-Daniel, Vellinga, Akke, Goossens, Herman, Butler, Christopher C, van der Velden, Alike, Anthierens, Sibyl, and Tonkin-Crine, Sarah

Published
2021

23. Primary care for patients with respiratory tract infection before and early on in the COVID-19 pandemic: an observational study in 16 European countries

Author

HAG Infectieziekten, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, van der Velden, Alike W, Bax, Eva A, Bongard, Emily, Munck Aabenhus, Rune, Anastasaki, Marilena, Anthierens, Sibyl, Balan, Anca, Böhmer, Femke, Bruno, Pascale, Chlabicz, Slawomir, Coenen, Samuel, Colliers, Annelies, Emmerich, Susanne, Garcia-Sangenis, Ana, Ghazaryan, Hrachuhi, van der Linde, Sanne R, Malania, Lile, Pauer, József, Tomacinschii, Angela, Tonkin-Crine, Sarah, Vellinga, Akke, Zastavnyy, Ihor, Verheij, Theo, Goossens, Herman, Butler, Christopher C, HAG Infectieziekten, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, van der Velden, Alike W, Bax, Eva A, Bongard, Emily, Munck Aabenhus, Rune, Anastasaki, Marilena, Anthierens, Sibyl, Balan, Anca, Böhmer, Femke, Bruno, Pascale, Chlabicz, Slawomir, Coenen, Samuel, Colliers, Annelies, Emmerich, Susanne, Garcia-Sangenis, Ana, Ghazaryan, Hrachuhi, van der Linde, Sanne R, Malania, Lile, Pauer, József, Tomacinschii, Angela, Tonkin-Crine, Sarah, Vellinga, Akke, Zastavnyy, Ihor, Verheij, Theo, Goossens, Herman, and Butler, Christopher C

Published
2021

24. Transformation of primary care during the COVID-19 pandemic: Experiences of healthcare professionals in eight European countries

Author

HAG Infectieziekten, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, Wanat, Marta, Hoste, Melanie, Gobat, Nina, Anastasaki, Marilena, Böhmer, Femke, Chlabicz, Slawomir, Colliers, Annelies, Farrell, Karen, Karkana, Maria Nefeli, Kinsman, John, Lionis, Christos, Marcinowicz, Ludmila, Reinhardt, Katrin, Skoglund, Ingmarie, Sundvall, Pär Daniel, Vellinga, Akke, Verheij, Theo J.M., Goossens, Herman, Butler, Christopher C., van der Velden, Alike, Anthierens, Sibyl, Tonkin-Crine, Sarah, HAG Infectieziekten, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, Wanat, Marta, Hoste, Melanie, Gobat, Nina, Anastasaki, Marilena, Böhmer, Femke, Chlabicz, Slawomir, Colliers, Annelies, Farrell, Karen, Karkana, Maria Nefeli, Kinsman, John, Lionis, Christos, Marcinowicz, Ludmila, Reinhardt, Katrin, Skoglund, Ingmarie, Sundvall, Pär Daniel, Vellinga, Akke, Verheij, Theo J.M., Goossens, Herman, Butler, Christopher C., van der Velden, Alike, Anthierens, Sibyl, and Tonkin-Crine, Sarah

Published
2021

25. Point-of-care testing, antibiotic prescribing, and prescribing confidence for respiratory tract infections in primary care: a prospective audit in 18 European countries.

Author

van der Velden, Alike W., van de Pol, Alma C., Bongard, Emily, Cianci, Daniela, Aabenhus, Rune, Balan, Anca, Böhmer, Femke, Lang, Valerija Bralić, Bruno, Pascale, Chlabicz, Slawomir, Coenen, Samuel, Colliers, Annelies, García-Sangenís, Ana, Ghazaryan, Hrachuhi, Godycki-Ćwirko, Maciej, Jensen, Siri, Lionis, Christos, van der Linde, Sanne R., Malania, Lile, and Pauer, Jozsef

Subjects
ANTIBIOTICS, AUDITING, CONFIDENCE, POINT-of-care testing, RESPIRATORY infections, PRIMARY health care, DRUG prescribing, PHYSICIAN practice patterns, LONGITUDINAL method
Abstract

Background: Between-country differences have been described in antibiotic prescribing for respiratory tract infection (RTI) in primary care, but not yet for diagnostic testing procedures and prescribing confidence. Aim: To describe between-country differences in RTI management, particularly diagnostic testing and antibiotic prescribing, and investigate which factors relate to antibiotic prescribing and GPs' prescribing confidence. Design & setting: Prospective audit in 18 European countries. Method: An audit of GP-registered patient, clinical, and management characteristics for patients presenting with sore throat and/or lower RTI (n = 4982), and GPs' confidence in their antibiotic prescribing decision. Factors related to antibiotic prescribing and confidence were analysed using multi-level logistic regression. Results: Antibiotic prescribing proportions varied considerably: <20% in four countries, and >40% in six countries. There was also considerable variation in point-of-care (POC) testing (0% in Croatia, Moldova, and Romania, and >65% in Denmark and Norway, mainly for C-reactive protein [CRP] and group A streptococcal [strep A] infection), and in laboratory or hospital-based testing (<3% in Hungary, the Netherlands, and Spain, and >30% in Croatia, Georgia, Greece, and Moldova, mainly chest X-ray and white blood cell counting). Antibiotic prescribing was related to illness severity, comorbidity, age, fever, and country, but not to having performed a POC test. In nearly 90% of consultations, GPs were confident in their antibiotic prescribing decision. Conclusion: Despite high confidence in decisions about antibiotic prescribing, there is considerable variation in the primary care of RTI in European countries, with GPs prescribing antibiotics overall more often than is considered appropriate. POC testing may enhance the quality of antibiotic prescribing decisions if it can safely reverse decisions confidently made on clinical grounds alone to prescribe antibiotics. [ABSTRACT FROM AUTHOR]

Published
2022
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27. The effect of interventions aiming to optimise the prescription of antibiotics in dental care—A systematic review

Author

Löffler, Christin and Böhmer, Femke

Subjects
Patients, Systematic Reviews, Oral Medicine, lcsh:Medicine, Research and Analysis Methods, Microbiology, Database and Informatics Methods, Antibiotics, Microbial Control, Outpatients, Medicine and Health Sciences, Humans, Database Searching, lcsh:Science, Dental Health Services, Pharmacology, Antimicrobials, lcsh:R, Drugs, Biology and Life Sciences, Research Assessment, Anti-Bacterial Agents, Health Care, Prescriptions, Dentistry, Antibiotic Resistance, lcsh:Q, Antimicrobial Resistance, Research Article
Abstract

Background Abundant evidence in dentistry suggests that antibiotics are prescribed despite the existence of guidelines aiming to reduce the development of antibiotic resistance. This review investigated (1) which type of interventions aiming to optimise prescription of antibiotics exist in dentistry, (2) the effect of these interventions and (3) the specific strengths and limitations of the studies reporting on these interventions. Method Literature search was based on Medline, Embase, Global Health, Cochrane CENTRAL, ClinicalTrials.gov and Current Controlled Trials. Studies with one of the two primary outcomes were included: (1) The number of antibiotics prescribed and/or (2) the accuracy of the prescription, commonly measured as a percentage of adherence to local clinical guidelines. Results Nine studies met these inclusion criteria. Five studies reported on the prescription of antibiotics in primary dental care and four studies focused on outpatient dental care. Interventions used in primary dental care included a combination of audit, feedback, education, local consensus, dissemination of guidelines and/or academic detailing. Trials in the outpatient setting made use of expert panel discussions, educational feedback on previous acts of prescribing, the dissemination of guidelines and the establishment of internal guidelines. All studies successfully reduced the number of antibiotics prescribed and/or increased the accuracy of the prescription. However, most studies were confounded by a high risk of selection bias, selective outcome reporting and high variance across study groups. In particular, information relating to study design and methodology was insufficient. Only three studies related the prescriptions to the number of patients treated with antibiotics. Conclusions This systematic review was able to offer conclusions which took the limitations of the investigated studies into account. Unfortunately, few studies could be included and many of these studies were confounded by a low quality of scientific reporting and lack of information regarding study methodology. High-quality research with objective and standardised outcome reporting, longer periods of follow-up, rigorous methodology and adequate standard of study reporting is urgently needed.

Published
2017

28. In vitro chlorhexidine release from alginate based microbeads for periodontal therapy

Author

Scholz, Malte, Reske, Thomas, Böhmer, Femke, Hornung, Anne, Grabow, Niels, and Lang, Hermann

Subjects
Teeth, Drug Administration, Infectious Disease Control, Physiology, Sanitization, Alginates, Immunology, Oral Medicine, lcsh:Medicine, In Vitro Techniques, Research and Analysis Methods, Pathology and Laboratory Medicine, Signs and Symptoms, Oral Diseases, Drug Therapy, Glucuronic Acid, Diagnostic Medicine, Medicine and Health Sciences, Humans, Public and Occupational Health, Particle Size, lcsh:Science, Saliva, Periodontitis, Immune Response, Periodontal Diseases, Liquid Chromatography, Inflammation, Pharmaceutics, Hexuronic Acids, lcsh:R, Chromatographic Techniques, Chlorhexidine, Biology and Life Sciences, High Performance Liquid Chromatography, Microspheres, Body Fluids, Health Care, Disinfection, Infectious Diseases, Jaw, Anti-Infective Agents, Local, lcsh:Q, Preventive Medicine, Anatomy, Drug Delivery, Digestive System, Head, Research Article
Abstract

Periodontitis is one of the most common infectious diseases globally that, if untreated, leads to destruction of the tooth supporting tissues and finally results in tooth loss. Evidence shows that standard procedures as mechanical root cleaning could be supported by further treatment options such as locally applied substances. Due to gingival crevicular fluid flow, substances are commonly washed out off the periodontal pockets. The evaluation of administration techniques and the development of local drug releasing devices is thus an important aspect in periodontal research. This study describes the development and examination of a new alginate based, biodegradable and easily applicable drug delivery system for chlorhexidine (CHX). Different micro beads were produced and loaded with CHX and the release profiles were investigated by high performance liquid chromatography (HPLC). The in vitro-demonstrated release of CHX from alginate based beads shows comparable releasing characteristics as clinically approved systems. Yet many characteristics of this new delivery system show to be favourable for periodontal therapy. Easy application by injection, low production costs and multifunctional adaptions to patient related specifics may improve the usage in routine care.

Published
2017

31. Did aetiology matter in illness duration and complications in patients presenting in primary care with acute respiratory tract infections early in the COVID-19 pandemic: An observational study in nine countries.

Author

Venekamp RP, Eijkemans MJC, Zuithoff NPA, Böhmer F, Chlabicz S, Colliers A, García-Sangenís A, Malania L, Pauer J, Tomacinschii A, Verheij TJ, Goossens H, Vellinga A, Butler CC, and van der Velden AW

Subjects
Humans, Male, Female, Middle Aged, Europe epidemiology, Adult, Aged, Time Factors, SARS-CoV-2, Acute Disease, COVID-19 complications, COVID-19 epidemiology, Primary Health Care, Respiratory Tract Infections epidemiology
Abstract

Background: Despite considerable research into COVID-19 sequelae, little is known about differences in illness duration and complications in patients presenting in primary care with symptoms of acute respiratory tract infections (RTI) that are and are not attributed to SARS-CoV-2 infection., Objective: To explore whether aetiology impacted course of illness and prediction of complications in patients presenting in primary care with symptoms of RTI early in the COVID-19 pandemic., Methods: Between April 2020-March 2021 general practitioners from nine European countries recruited consecutively contacting patients with RTI symptoms. At baseline, an oropharyngeal-nasal swab was obtained for aetiology determination using PCR after follow-up of 28 days. Time to self-reported recovery was analysed with Kaplan-Meier curves. Predictors (baseline variables of demographics, patient and disease characteristics) of a complicated course (composite of hospital admission and persisting signs/symptoms at 28 days follow-up) were explored with logistic regression modelling., Results: Of 855 patients with RTI symptoms, 237 (27.7%) tested SARS-CoV-2 positive. The proportion not feeling fully recovered (15.6% vs 18.1%, p  = 0.39), reporting being extremely tired (9.7% vs 12.8%, p  = 0.21), and not having returned to usual daily activities (18.1% vs 14.4%, p  = 0.18) at day 28 were comparable between SARS-CoV-2 positive ( n  = 237) and negative ( n  = 618) groups. However, among those feeling fully recovered (SARS-CoV-2 positive: 200 patients, SARS-CoV-2 negative: 506 patients), time to full recovery was significantly longer in SARS-CoV-2 patients (10.6 vs 7.7 days, p  < 0.001). We found no evidence that predictors of a complicated course differed between groups ( p  = 0.07)., Conclusion: Early in the pandemic, the proportion of patients not feeling fully recovered by 28 days was similar between SARS-CoV-2 positive and negative patients presenting in primary care with RTI symptoms, but it took somewhat longer for SARS-CoV-2 patients to feel fully recovered. More research is needed on predictors of a complicated course in RTI.

Published
2024
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32. Disease-Specific Quality Indicators for Outpatient Antibiotic Prescribing for Respiratory Infections (ESAC Quality Indicators) Applied to Point Prevalence Audit Surveys in General Practices in 13 European Countries.

Author

Vellinga A, Luke-Currier A, Garzón-Orjuela N, Aabenhus R, Anastasaki M, Balan A, Böhmer F, Lang VB, Chlabicz S, Coenen S, García-Sangenís A, Kowalczyk A, Malania L, Tomacinschii A, van der Linde SR, Bongard E, Butler CC, Goossens H, and van der Velden AW

Abstract

Up to 80% of antibiotics are prescribed in the community. An assessment of prescribing by indication will help to identify areas where improvement can be made. A point prevalence audit study (PPAS) of consecutive respiratory tract infection (RTI) consultations in general practices in 13 European countries was conducted in January-February 2020 (PPAS-1) and again in 2022 (PPAS-4). The European Surveillance of Antibiotic Consumption quality indicators (ESAC-QI) were calculated to identify where improvements can be made. A total of 3618 consultations were recorded for PPAS-1 and 2655 in PPAS-4. Bacterial aetiology was suspected in 26% (PPAS-1) and 12% (PPAS-4), and an antibiotic was prescribed in 30% (PPAS-1) and 16% (PPAS-4) of consultations. The percentage of adult patients with bronchitis who receive an antibiotic should, according to the ESAC-QI, not exceed 30%, which was not met by participating practices in any country except Denmark and Spain. For patients (≥1) with acute upper RTI, less than 20% should be prescribed an antibiotic, which was achieved by general practices in most countries, except Ireland (both PPAS), Croatia (PPAS-1), and Greece (PPAS-4) where prescribing for acute or chronic sinusitis (0-20%) was also exceeded. For pneumonia in adults, prescribing is acceptable for 90-100%, and this is lower in most countries. Prescribing for tonsillitis (≥1) exceeded the ESAC-QI (0-20%) in all countries and was 69% (PPAS-1) and 75% (PPAS-4). In conclusion, ESAC-QI applied to PPAS outcomes allows us to evaluate appropriate antibiotic prescribing by indication and benchmark general practices and countries.

Published
2023
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33. [20-year-old man with adynamia and syncopes].

Author

Schilling E, Böhmer F, and Fritzsche C

Subjects
Adrenal Insufficiency diagnosis, Adrenal Insufficiency drug therapy, Adrenocorticotropic Hormone blood, Animals, Creatine blood, Diagnosis, Differential, Humans, Hydrocortisone therapeutic use, Hyperpigmentation drug therapy, Hyperpigmentation etiology, Hyponatremia drug therapy, Hyponatremia etiology, Male, Muscle Weakness drug therapy, Syncope drug therapy, Weight Loss, Young Adult, Adrenal Insufficiency congenital, Muscle Weakness etiology, Syncope etiology
Abstract

Competing Interests: Carlos Fritzsche erhielt in den letzten 3 Jahren Vortragshonorare von MSD und GILEAD, sowie Reisekostenunterstützung von GILEAD. Für Elisa Schilling und Femke Böhmer liegen keine Konflikte vor.

Published
2020
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