Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Assessing Reduction of Antibiotic Prescribing for Acute, Non-complicated Infections in Primary Care in Germany: Multi-step Outcome Evaluation in the Cluster-Randomized Trial ARena

Version 1 : Received: 6 September 2021 / Approved: 7 September 2021 / Online: 7 September 2021 (13:54:02 CEST)

A peer-reviewed article of this Preprint also exists.

Poss-Doering, R.; Kronsteiner, D.; Kamradt, M.; Kaufmann-Kolle, P.; Andres, E.; Wambach, V.; Bleek, J.; Wensing, M.; Group, A.-S.; Szecsenyi, J. Assessing Reduction of Antibiotic Prescribing for Acute, Non-Complicated Infections in Primary Care in Germany: Multi-Step Outcome Evaluation in the Cluster-Randomized Trial ARena. Antibiotics 2021, 10, 1151. Poss-Doering, R.; Kronsteiner, D.; Kamradt, M.; Kaufmann-Kolle, P.; Andres, E.; Wambach, V.; Bleek, J.; Wensing, M.; Group, A.-S.; Szecsenyi, J. Assessing Reduction of Antibiotic Prescribing for Acute, Non-Complicated Infections in Primary Care in Germany: Multi-Step Outcome Evaluation in the Cluster-Randomized Trial ARena. Antibiotics 2021, 10, 1151.

Journal reference: Antibiotics 2021, 10, 1151
DOI: 10.3390/antibiotics10101151

Abstract

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 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 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. Trial registration: ISRCTN, ISRCTN58150046

Keywords

antimicrobial resistance; antibiotic prescribing; acute non-complicated infections; primary care; data-based feedback; mixed logistic regression model; multi-faceted intervention

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