Biomedical subjects

Annemiek E Akkerman

Publications and source records attributed to Annemiek E Akkerman.

5 recordsLinked to original sources

PubMed2005

Determinants of antibiotic overprescribing in respiratory tract infections in general practice.

OBJECTIVES: To assess determinants of antibiotic overprescribing in patients with sinusitis, tonsillitis and bronchitis in Dutch general practice. PATIENTS AND METHODS: A total of 146 general practitioners (GPs) from The Netherlands included all patients with sinusitis, tonsillitis and bronchitis during a 4 week period in the winter of 2002/2003, and recorded patient characteristics, clinical presentation and management. Overprescribing of antibiotics was assessed using the recommendations of the Dutch national guidelines as a benchmark. RESULTS: In almost 50% of all 1469 respiratory tract infection (RTI) consultations (694/1469), the antibiotic prescribing decisions were in accordance with the recommendations of the Dutch national guidelines. Overprescribing was highest in tonsillitis and bronchitis [71% (168/238) and 63% (415/656), respectively], while in sinusitis this was only 22% (128/575). Underprescribing was seen in 1% (3/238), 3% (17/656) and 8% (44/575), respectively. Patients who received an antibiotic prescription that was not in accordance with the guidelines had more inflammation signs such as fever (ORs 2.08, 2.18 and 3.04, for sinusitis, tonsillitis and bronchitis, respectively), were more severely ill according to their GP (ORs 2.37, 1.87 and 1.42, respectively), and their GP assumed more often that they expected an antibiotic (ORs 1.95, 1.70 and 2.11, respectively), compared with those who did not receive an antibiotic prescription. CONCLUSIONS: GPs overestimate symptoms and probably patients' expectations when indicating antibiotic therapy in RTI cases in daily practice. Correct interpretation of combinations of symptoms for antibiotic treatment should be emphasized, combined with adopting more patient-centred consulting skills to rationalize the prescribing of antibiotics.

Anti-Bacterial Agents↗

PubMed2005

Analysis of under- and overprescribing of antibiotics in acute otitis media in general practice.

OBJECTIVES: To assess clinical determinants of under- and overprescribing of antibiotics according to the Dutch national guideline for patients with acute otitis media (AOM) in general practice. PATIENTS AND METHODS: A total of 146 general practitioners (GPs) from the Netherlands included all patients with AOM during a 4 week period in winter, and recorded patient characteristics, clinical presentation and management. Under- and overprescribing of antibiotics in AOM was assessed using the Dutch national guideline. RESULTS: A total of 458 AOM consultations were recorded. In seven out of 10 consultations (310/439; excluding 19 consultations in which patients were referred to secondary care), antibiotic prescribing decisions were according to the national guideline. In 11% of all consultations (50/439), there was underprescribing and in 18% (79/439) there was overprescribing. Patients with an antibiotic indication but without an antibiotic prescription (underprescribing; n=50) had more short-term symptoms (OR: 0.93), relatively few inflammation signs (OR: 0.47) and were less severely ill (OR: 0.30), compared with patients with an antibiotic indication and an antibiotic prescription (n=167). Patients without an antibiotic indication but with an antibiotic prescription (overprescribing; n=79) were more often younger than 24 months (OR: 0.34), more severely ill (OR: 3.30) and expected more often an antibiotic as perceived by their GP (OR: 2.11), compared with patients without an antibiotic indication and without an antibiotic prescription (n=143). CONCLUSIONS: Clinical determinants which are stated as criteria for antibiotic treatment of AOM in the Dutch national guideline were recognized by GPs as important items, but were frequently given too much weight.

Adolescent↗

PubMed2005

Prescribing antibiotics for respiratory tract infections by GPs: management and prescriber characteristics.

BACKGROUND: Due to clinical and non-clinical factors, considerable variation exists in the prescribing of antibiotics for respiratory tract infections (RTIs) by GPs based in the Netherlands. AIM: To assess, in patients with RTIs in Dutch general practice: the prescribing rates of antibiotics; the relationship between GP characteristics and antibiotic prescribing; and the type of antibiotics prescribed. DESIGN OF STUDY: Descriptive and prognostic. SETTING: Eighty-four GPs in the middle region of the Netherlands. METHOD: All patient consultations for RTIs were registered by 84 GPs during 3 weeks in autumn and winter 2001 and 2002. In addition, all GPs completed a questionnaire related to individual and practice characteristics. RESULTS: The mean proportion of consultations in which GPs prescribed antibiotics was 33% (95% CI = 29 to 35%) of all RTIs. This proportion varied from 21% for patients with upper RTIs or an exacerbation of asthma/COPD, to about 70% when patients had sinusitis-like complaints or pneumonia. Amoxycillin and doxycycline were the most frequently prescribed antibiotics, while 17% of the antibiotics prescribed were macrolides. Multiple linear regression analysis showed that the longer GPs had practised, the more frequently they prescribed antibiotics, especially in combination with relatively little knowledge about RTIs or the less time GPs felt they had available per patient. The final model, with seven factors, explained 29% of the variance of antibiotic prescribing. CONCLUSION: The prescribing behaviour of Dutch GPs might be improved with regard to choice of type and indication of antibiotics.

Adolescent↗

PubMed2004

Antibiotic prescribing for respiratory tract infections in Dutch primary care in relation to patient age and clinical entities.

OBJECTIVES: To obtain detailed information on current prescribing rates of antibiotics for respiratory tract infections (RTIs) in Dutch general practice and its relation with age and respiratory tract clinical entities. METHODS: We assessed the mean proportion of antibiotics prescribed for RTIs per age group, contact-based and population-based using all patient contacts concerning RTIs in the year 2000 selected from the IPCI database, containing information on general practice consultations of 235,290 patients. RESULTS: In one-third of all contacts concerning RTIs, antibiotics were prescribed, with much variation between age groups and clinical entities. For children (0-15 years) and the elderly (over 75 years), the lowest contact-based percentages of prescribed antibiotics for RTIs were found, while population-based, children of age 0-5 years received far more antibiotics for RTIs. High prescribing rates were seen in patients with sinusitis-like complaints (67%) or pneumonia (78%), whereas low rates were found for patients with upper RTIs (16%). CONCLUSIONS: Potential over-prescribing of antibiotics for RTIs occurs in the age group 31-65 years, not in children and the elderly, and in patients with upper RTIs, sinusitis and most likely acute bronchitis (contact-based). The management of these subgroups of patients should be addressed in quality assurance programmes. Children and the elderly visit the GP much more often than adults, which can be explained by more frequent (children) or more severe (elderly) RTI morbidity, but in proportion they do not receive more antibiotics.

Adolescent↗

PubMed2003

Left-right differences in Eustachian tube function in children with ventilation tubes.

OBJECTIVE: To study the intraindividual variation in Eustachian tube (ET) function in children with ventilation tubes. METHODS: The forced response test, the pressure equilibration test and the sniff test were performed on both ears of 148 children. The results of both ears were compared. RESULTS: No systematic differences were found between the left and the right ears. However, the intraindividual variation was very pronounced. The variation in passive ET function within children was of similar magnitude as the variation in passive ET function between children. Twenty-eight percent of the children had different active ET function in both ears and 15% had an opposite result in each ear with respect to the sniff test. CONCLUSIONS: This study shows that ET function is much more a characteristic of the individual ear than of the individual child. These findings also question the validity of trials on ET function or middle ear disease that use the opposite ear as a control (split level design).

Child↗