Antibiotics prescription in primary care: a 5-year follow-up of an educational programme.

An educational programme on the use of antibiotics for respiratory tract infections (RTIs) in primary care, initiated among district physicians at the Community Health Centre of Höör, Sweden in 1985, resulted in an overall reduction in prescriptions for antibiotics, particularly broad-spectrum antibiotics. The aim of the present study was to evaluate the long-term effects of the programme on antibiotic prescription patterns at the centre. Since 1985, computerized records have been kept of every consultation at the centre, including details of the attending physician, the patient, diagnosis and type of antibiotic prescribed. Moreover, during a 3-month period in 1991, each pharmacy in the region recorded details of all prescriptions for antibiotics dispensed. Estimated immediately after the programme, the proportion of RTI patients prescribed antibiotics had fallen to 44%, a figure virtually unchanged 5 years later. During the subsequent five-year period, antibiotics dispensed at the pharmacy in Höör were further reduced from 14.1 to 13.2 defined daily doses 1000 inhabitants-1 day-1. As compared with district physicians at other community health centres in the region, those at Höör prescribed more penicillin V (80% of all antibiotic prescriptions) and less broad-spectrum antibiotics. The educational programme, combined with an active interest among district physicians at Höör in current research into antibiotic usage, has thus wrought enduring changes in the pattern of antibiotic prescription. A probable contributory factor was the district physicians' awareness that the computerized registration of diagnosis and treatment enables prescription patterns to be audited at an individual level.