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ANTIBIOTIC USE IN COMMUNITY ACQUIRED PNEUMONIA (CAP) IN PRIMARY CARE

Nena Kopcavar Gucek , MD, Msc Community Health Center Ljubljana and Department of Family Medicine Medical School University of Ljubljana. ANTIBIOTIC USE IN COMMUNITY ACQUIRED PNEUMONIA (CAP) IN PRIMARY CARE. Contents of presentation. Drugs prescribing in GP/FM

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ANTIBIOTIC USE IN COMMUNITY ACQUIRED PNEUMONIA (CAP) IN PRIMARY CARE

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  1. NenaKopcavarGucek, MD, Msc CommunityHealth Center Ljubljana and DepartmentofFamily Medicine MedicalSchool Universityof Ljubljana ANTIBIOTIC USE IN COMMUNITY ACQUIRED PNEUMONIA (CAP) IN PRIMARY CARE

  2. Contentsofpresentation • Drugs prescribing in GP/FM • Primary care in Slovenia-basic data • Guidelines and recommendations for treatment of CAP on primary level • Adherence to recommendations • Proposals for improvement

  3. Contributing factors for the pattern of drugs prescribing in GP/FP(1)-PERMANENT -prescription as a symbol (token, proof of severity of condition) -influence of a (long-term)relationship between doctor and patient: trust and partnership -time factor -characteristics of the practice: rural vs city, student clinic vs nursing home etc.)

  4. Contributing factors for the pattern of drugs prescribing in GP/FP(2)-VARYING -professionalguidelinesandrecommendations -the register ofavailabledrugs in Slovernia (IPH; every 2 years) -List ofdrugs in Slovenia (SlovenianHealthInsuranceCmpany, every 6 months) -epidemiology, resistance -ageingofthepopulation -developmentofnewdrugs (anddiseases) -….?

  5. Slovenian GP/FP (1)-general data -890 physicians (general/familypractice) per 2 mio inhabitants -specialtyforpractising GP/FP requiredsince 2007 -role in thehealthcarescheme-»gatekeeper«-»coordinator« Švab I, Petek Šter M, Kersnik J, Živčec Kalan G, Car J. A cross-sectionalstudyofperformanceofSlovene general practitioners. Zdrav Var 2005; (44): 183-92.

  6. Slovenian GP/FP (2)-workload -42 doctorsregistered 300 consecutivevisits -12.296 consultations in GP/FP wereanalysed -on average 46,5 consulationsperdoctorperday -average time perconsultationmeasured 7,08 min (8,5 min exam) -20,2% ofvisitorswerereferred to secondarylevel (83% urgent) Švab I, Petek Šter M, Kersnik J, Živčec Kalan G, Car J. A cross-sectionalstudyofperformanceofSlovene general practitioners. Zdrav Var 2005; (44): 183-92.

  7. Slovenian GP/FP (3)- Statisticsofhealthproblems -27,8% ofvisitorsdiagnosedwithacutedisease -16,8% ofallvisitorswerediagnosedwithrespiratorydisease (cardiovasc 26,5% andmusculoscelet 24,7%) -outofall, 58,1%ofvisitorsreceivedprescription(s) -1,95 prescriptionpervisitor (1 to 9, SD 1,342) Švab I, Petek Šter M, Kersnik J, Živčec Kalan G, Car J. A cross-sectionalstudyofperformanceofSlovene general practitioners. Zdrav Var 2005; (44): 183-92.

  8. Slovenian GP/FP(4)-Issues in prescribingdrugs -FP/GP prescribe more than 70% ofalldrugs in theoutpatientsettings -72% inhabitantsof R Sloveniareceive at least 1 precriptionperyear (MEDICALISATION?) -23.000 Slovenianswereprescriberd more than 10 differentdrugs (INTERACTIONS?) -suchpatternofprescribingwasobserved in 500 Sloveniandoctors (RATIONALITY?) Jurij Fuerst, ISIS 20 (7):14-6.

  9. Guidelines and recommendations for treating CAP on primary level 1. Čižman M, Beović B. Manualforprescribingofantimicrobaldrugs in primarysetting. Ljubljana, Arcadia, 2002. 2. Mušič M, Osolnik K, Tomič V, Eržen R, Košnik M, Beović B, Lejko Zupanc T, Strle F, Vodopivec Jamšek V, Živčec Kalan G, Švab I, Sočan M. Recommendationsforthemanagementofcommunityacquiredpneumonia inadults 3.http://www.szd.si/user_files/vsebina/Zdravniski_Vestnik/2010/marec/245-64.pdf

  10. Sensitivity of causing agents for lower respitarory tract infections in Slovenia in 2004 (Seme K and al, Infectologic Symposium Ljubljana 2004) • H. influenzae S for ampicillin(amoxicillin=97,7% • M. catharralis S for ampicillin/amoxicillin=65%

  11. Prospectivestudy (1) -109 GP/FP included 1000 pts -dobledatauptake: questionnairefordoctorsandquestionnaireforpatiens -2 focuses: useofantibioticsandimpactofantibiotics on patients˙recovery KLEMENC-KETIŠ, Zalika, DREŠČEK, Marko, KLEMEN, Maja, KERSNIK, Janko. Impactofantibiotictreatment on lowerrespiratorytractsymptoms. V: POPLAS-SUSIČ, Tonka (ur.), VAJD, Rajko (ur.). [Zbornik predavanj], (Medicinski razgledi, Supplement, letn. 50, suppl. 1). Ljubljana: Medicinski razgledi, 2011, str. 57-61.

  12. Prospectivestudy (2) Prescribing of antibiotics in patients with pneumonia: • -penicillin 42,4% • -penicillin and clavulonic acid 18% • -macrolids 33,3% • -quinolones 6,1% (sensitivity to penicillin only in 10% of Slovenian population!)

  13. Prospectivestudy (3) • Longer duration of symptoms was not related to prescription of antibiotic. • Contributing factors to longer duration of respiratory tract infection were strongly correlated with: -pneumonia -duration of symptoms prior to visit to GP/FP -presence of asthma

  14. PROTIMIKROBNA ZDRAVILA poraba zdravil v letu 2008 v štev. DDD na 1000 prebiv. na dan

  15. PROTIMIKROBNA ZDRAVILA poraba zdravil v letih 2006, 2007 in 2008 v štev. DDD na 1000 prebiv. na dan

  16. Kinoloni (ciprofloksacin, norfloksacin, pefloksacin) ter sulfometoksazol s trimetoprimom poraba zdravil v letu 2008 v štev. DDD na 1000 prebiv. na dan

  17. Primerjava med porabo amoksicilina ter kombinacije amoksicilina s klavulansko kislino poraba zdravil v letu 2008 v štev. DDD na 1000 prebiv. na dan

  18. Primerjava med porabo amoksicilina ter kombinacije amoksicilina s klavulansko kislino poraba zdravil v letu 2008 v deležu štev. DDD na 1000 prebiv. na dan

  19. Poraba antibiotikov po OE v DDD pri otrocih do 19. leta in odraslih v 2008

  20. CONCLUSION -Antibiotics in CAP in Slovenia are not prescribed in accordancewithguidelinesandrecommendations. -Education on severallevelscouldimprovethepatternofprescribing. - Not onlyprofessional, butalsolaypublicshouldandalreadyhasbeentargeted. -Commongoalsamongpolicymakers, healthprofessionalandpatientsshouldbeemphasized.

  21. A great secret of success is to go through life as a man who never gets used up. A. Schweitzer

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