One area for improvement is that around 1 in 3 antibiotics prescriptions does not comply with Dutch College of General Practitioners (NHG) guidelines. In addition, antibiotics prescription practices vary widely among GPs: some prescribe antibiotics up to 6 times more often per 1,000 registered patients than others. This gap cannot be explained by differences in the patient composition of the GP practice.
Protocol for a periodic consultation (FTO) between individual GP groups in a region on appropriate antibiotics use
RIVM has developed a protocol for appropriate antibiotics use in partnership with University Medical Center (UMC) Utrecht, partly based on consultations with the NHG and the National Association of General Practitioners (LHV). This protocol is an initiative of several GP practices that have adopted an appropriate antibiotics use cycle following a pharmacotherapeutic consultation (farmacotherapeutisch overleg, FTO). The protocol consists of the following steps:
- Conclude an agreement between the GP practices that participate in an FTO and one of the external parties: STIZON/INSZO or VIP Calculus (parties concerned with data management of patient data). Many GP practices already have such an agreement in place because they are required to provide various other quality indicators.
- The external party collects data and incorporates these into a report about the predetermined quality indicators. As standard, both STIZON/INSZO and VIP Calculus make the report about these indicators available to the GP practices affiliated with them.
- Prepare a comparative report based on the quality indicators of the different GP practices. This is done by someone who is involved in organising the FTO on appropriate antibiotics use, e.g. an expert GP or epidemiologist. The comparative report is drawn up for each GP practice separately, so that the figures can be compared to those of the other GP practices that participate in the FTO and to national figures.
- Discuss the comparative reports as part of a special FTO on appropriate antibiotics use and organise further training on appropriate antibiotics use. The FTO is led by an expert GP who is trained to interpret the comparative report and present it to the FTO participants.
Content of the FTO on appropriate antibiotics use
The aim of the FTO is to use the comparative information to give GPs insight into how they prescribe antibiotics compared to their colleagues. This helps to determine where improvements can be made. GPs who took part in the pilot project appreciated the FTO components. Read the article about the first pilot project. The comparative information mentioned is generated based on data from the GPs’ own information system (huisartsinformatiesysteem, HIS). The FTO addresses the following topics:
- Trends in antibiotics use
- Pros and cons of antibiotics
- NHG guidelines (respiratory tract infections, urinary tract infections and skin infections)
- Research data on the quality of antibiotics prescriptions in the Netherlands
- Explanation and presentation of the quality indicators
- GP-patient communication about antibiotics
- Case studies and C-reactive protein (CRP) tests
- Responsible antibiotics policy and potential points for improvement
Expert GPs who can organise an FTO on appropriate antibiotics use are available within each regional care network. Get in touch with the contact person in your region for more information.
- Northern Netherlands Care Network: Wim Niessen
- Euroregion Zwolle Care Network: Sandra de Jong
- Gelderland Antimicrobial Resistance and Infection Prevention Network (GAIN): Marjon Kamp
- Utrecht Care Network: Lieselotte Koevoets
- North Holland East/Flevoland Care Network: Hanne van Lier
- Holland West Care Network: Martijn Sijbom
- South-West Netherlands Care Network: Laurence Walhout
- North Brabant Care Network (Rezisto): Dre Bartels
- Limburg Infection Prevention and Antimicrobial Resistance Network (LINK): Wen Roks
Development of the strategy
The national strategy to combat antimicrobial resistance (AMR)– which was launched by the Minister of Health, Welfare and Sport in 2015 – and the associated multi-year agenda describe various activities to prevent the emergence and spread of antimicrobial resistance. An important aim of this effort is to reduce the inappropriate use of antibiotics.
Annual report in NethMap (Consumption of antimicrobial agents and antimicrobial resistance among medically important bacteria in the Netherlands)
The use of different types of antibiotics is reported annually in NethMap, a joint production of RIVM and SWAB (a working group for antibiotics policy in the Netherlands). However, the surveillance of appropriate prescription practices is more complicated. There is currently little insight regarding the extent to which prescriptions for antibiotics are in line with the applicable guidelines.
Pilot project on behalf of the Ministry of Health, Welfare and Sport
To address this issue, the Ministry of Health, Welfare and Sport commissioned a pilot project on appropriate antibiotics use for primary care providers in 2017, with a relevant and useful set of indicators of antibiotics prescription policy. These indicators linked prescriptions to indications per disease episode. Based on the first pilot project round, the method was refined and further indicators were added in 2019. In parallel to these follow-up steps, a project team from UMC Utrecht and Radboud University Medical Center (Radboudumc) carried out a comparative information on antibiotics in primary care project (Spiegelinformatie Antibiotica Eerstelijn, SABEL) in two regional antimicrobial resistance (AMR) care networks. The aim of the SABEL project was to roll out the protocol further, while also training expert GPs to organise the FTO further training meeting with associated comparative data. The participating GPs and pharmacists were enthusiastic about both the protocol and the FTO.
The roll-out of the FTOs on appropriate antibiotics use through the regional AMR care networks began in 2020.