Poss-Doering Regina, Kronsteiner Dorothea, Kamradt Martina, Kaufmann-Kolle Petra, Andres Edith, Wambach Veit, Bleek Julian, Wensing Michel, Szecsenyi Joachim
Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany.
Institute of Medical Biometry, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany.
Antibiotics (Basel). 2021 Sep 24;10(10):1151. doi: 10.3390/antibiotics10101151.
The three-armed cluster-randomized trial ARena (sustainable reduction of antibiotic-induced antimicrobial resistance) aimed to foster appropriate antibiotic use and reduce overprescribing in German ambulatory care to counter antibiotic resistance. Multi-faceted interventions targeted primary care physicians, teams and patients. This study examined the effectiveness of the implementation program. ARena was conducted in 14 primary care networks with 196 practices. All arms received data-based feedback on antibiotics prescribing and quality circles. Arms II and III received different add-on components each. Primary outcome examined is the prescribing rate for systemic antibiotics for cases with non-complicated acute infections (upper respiratory tract, bronchitis, sinusitis, tonsillitis, otitis media). Secondary outcomes refer to the prescribing of quinolones and guideline-recommended antibiotics. Based on pseudonymized quarterly claims data, mixed logistic regression models examined pre-post intervention antibiotic prescribing rate changes and compared to matched standard care. A significant rate reduction (arm I 11.7%; arm II 9.9%; arm III 12.7%) and significantly lower prescribing rates were observed for all arms (20.1%, 18.9% and 23.6%) compared to matched standard care (29.4%). Fluoroquinolone prescribing was reduced in all intervention arms and rates for recommended substances generally increased. No significant post-interventional difference between intervention arms was detected. Findings indicate implementation program impact compared to standard care.
三臂整群随机试验ARena（抗生素诱导的抗菌药物耐药性可持续降低）旨在促进德国门诊医疗中抗生素的合理使用，减少过度处方，以应对抗生素耐药性问题。多方面干预措施针对基层医疗医生、团队和患者。本研究考察了实施项目的有效性。ARena试验在14个基层医疗网络中的196家医疗机构开展。所有组均收到关于抗生素处方和质量改进小组的基于数据的反馈。第二组和第三组分别接受了不同的附加组件。所考察的主要结局是非复杂性急性感染（上呼吸道感染、支气管炎、鼻窦炎、扁桃体炎、中耳炎）病例的全身用抗生素处方率。次要结局涉及喹诺酮类药物和指南推荐抗生素的处方情况。基于匿名的季度理赔数据，混合逻辑回归模型检验了干预前后抗生素处方率的变化，并与匹配的标准治疗进行比较。与匹配的标准治疗（29.4%）相比，所有组均观察到显著的率降低（第一组11.7%；第二组9.9%；第三组12.7%），且所有组的处方率均显著更低（20.1%、18.9%和23.6%）。所有干预组的氟喹诺酮类药物处方均减少，推荐药物的使用率总体上升。干预组之间未检测到显著的干预后差异。研究结果表明，与标准治疗相比，实施项目具有影响。
