Dataset Information

Antibiotic resistance in primary care in Austria - a systematic review of scientific and grey literature.

ABSTRACT:

Background

Antibiotic resistance is an increasing challenge for health care services worldwide. While up to 90% of antibiotics are being prescribed in the outpatient sector recommendations for the treatment of community-acquired infections are usually based on resistance findings from hospitalized patients. In context of the EU-project called "APRES - the appropriateness of prescribing antibiotic in primary health care in Europe with respect to antibiotic resistance" it was our aim to gain detailed information about the resistance data from Austria in both the scientific and the grey literature.

Methods

A systematic review was performed including scientific and grey literature published between 2000 and 2010. Inclusion and exclusion criteria were defined and the review process followed published recommendations.

Results

Seventeen scientific articles and 23 grey literature documents could be found. In contrast to the grey literature, the scientific publications describe only a small part of the resistance situation in the primary health care sector in Austria. Merely half of these publications contain data from the ambulatory sector exclusively but these data are older than ten years, are very heterogeneous concerning the observed time period, the number and origin of the isolates and the kind of bacteria analysed. The grey literature yields more comprehensive and up-to-date information of the content of interest. These sources are available in German only and are not easily accessible. The resistance situation described in the grey literature can be summarized as rather stable over the last two years. For Escherichia coli e.g. the highest antibiotic resistance rates can be seen with fluorochiniolones (19%) and trimethoprim/sulfamethoxazole (27%).

Conclusion

Comprehensive and up-to-date antibiotic resistance data of different pathogens isolated from the community level in Austria are presented. They could be found mainly in the grey literature, only few are published in peer-reviewed journals. The grey literature, therefore, is a very valuable source of relevant information. It could be speculated that the situation of published literature is similar in other countries as well.

SUBMITTER: Hoffmann K

PROVIDER: S-EPMC3245451 | biostudies-literature | 2011 Nov

REPOSITORIES: biostudies-literature

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Publications

Antibiotic resistance in primary care in Austria - a systematic review of scientific and grey literature.

Hoffmann Kathryn K Wagner Gernot G Apfalter Petra P Maier Manfred M

BMC infectious diseases 20111128

<h4>Background</h4>Antibiotic resistance is an increasing challenge for health care services worldwide. While up to 90% of antibiotics are being prescribed in the outpatient sector recommendations for the treatment of community-acquired infections are usually based on resistance findings from hospitalized patients. In context of the EU-project called "APRES - the appropriateness of prescribing antibiotic in primary health care in Europe with respect to antibiotic resistance" it was our aim to ga ...[more]

PMID: 22123085

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Project description:BackgroundPrimary care in England is facing increasing pressure due to the increasing number and complexity of consultations and the declining number of doctors per head of population. The improvement of primary care efficiency and productivity should be a priority, to ensure that future investments in the medical workforce can cope with the increasingly large and complex demand for care.ObjectivesThis paper presents a systematic literature review of studies that define or measure efficiency in primary care in high-income settings. The review of the existing definitions of primary care efficiency and their limitations will inform future research on the measurement of efficiency in primary care in England and its determinants.MethodsLiterature searches were performed on Embase, Medline, and EconLit in January 2020. The records that passed the screening were reviewed in full text, and data on the study settings, the efficiency definition, and the efficiency analysis were extracted.ResultsOf the 2590 non-duplicate records retrieved from the searches, 38 papers were included in the analysis. The volume of the literature on primary care efficiency has evolved significantly from the 1980s, with the majority of the published studies focussing on European health systems. The setting most often analysed was primary care centres. Output was usually expressed using measures of primary care utilisation, with or without quality adjustments. Reference to the health outcomes achieved was, however, limited. Inputs were more commonly expressed in labour terms, while the exogenous variables related either to the characteristics of the patient population or the organisation of primary care. While all studies included an analysis of technical efficiency, consideration of allocative or cost efficiency or the determinants of productivity (e.g. technological change, skill mix) was rare.ConclusionsThe main limitations that future research on primary care efficiency should address relate to the definition of output. Current approaches to measure the impact on health and the multiple dimensions of output are not sufficient to represent the valued output of primary care. In light of the recent changes in the model of primary care delivery in England, future research should also investigate the impact of technological change on productivity and the scope for substitution across staff roles.

Project description:BackgroundThere has been growing international interest in performing remote consultations in primary care, particularly amidst the current COVID-19 pandemic. Despite this, the evidence surrounding the safety of remote consultations is inconclusive. The appropriateness of antibiotic prescribing in remote consultations is an important aspect of patient safety that needs to be addressed.ObjectiveThis study aimed to summarize evidence on the impact of remote consultation in primary care with regard to antibiotic prescribing.MethodsSearches were conducted in MEDLINE, Embase, HMIC, PsycINFO, and CINAHL for literature published since the databases' inception to February 2020. Peer-reviewed studies conducted in primary health care settings were included. All remote consultation types were considered, and studies were required to report any quantitative measure of antibiotic prescribing to be included in this systematic review. Studies were excluded if there were no comparison groups (face-to-face consultations).ResultsIn total, 12 studies were identified. Of these, 4 studies reported higher antibiotic-prescribing rates, 5 studies reported lower antibiotic-prescribing rates, and 3 studies reported similar antibiotic-prescribing rates in remote consultations compared with face-to-face consultations. Guideline-concordant prescribing was not significantly different between remote and face-to-face consultations for patients with sinusitis, but conflicting results were found for patients with acute respiratory infections. Mixed evidence was found for follow-up visit rates after remote and face-to-face consultations.ConclusionsThere is insufficient evidence to confidently conclude that remote consulting has a significant impact on antibiotic prescribing in primary care. However, studies indicating higher prescribing rates in remote consultations than in face-to-face consultations are a concern. Further, well-conducted studies are needed to inform safe and appropriate implementation of remote consulting to ensure that there is no unintended impact on antimicrobial resistance.

Project description:Purpose The significant individual and societal burden of work disability could be reduced if supportive workplace strategies could be added to evidence-based clinical treatment and rehabilitation to improve return-to-work (RTW) and other disability outcomes. The goal of this article is to summarize existing research on workplace interventions to prevent disability, relate these to employer disability management practices, and recommend future research priorities. Methods The authors participated in a year-long collaboration that ultimately led to an invited 3-day conference, Improving Research of Employer Practices to Prevent Disability, held October 14-16, 2015, in Hopkinton, Massachusetts, USA. The collaboration included a topical review of the literature, group conference calls to identify key areas and challenges, drafting of initial documents, review of industry publications, and a conference presentation that included feedback from peer researchers and a question/answer session with an expert panel with direct employer experience. Results Evidence from randomized trials and other research designs has shown general support for job modification, RTW coordination, and organizational support, but evidence is still lacking for interventions at a more granular level. Grey literature reports focused mainly on job re-design and work organization. Panel feedback focused on organizational readiness and the beliefs and values of senior managers as critical factors in facilitating changes to disability management practices. While the scientific literature is focused on facilitating improved coping and reducing discomforts for individual workers, the employer-directed grey literature is focused on making group-level changes to policies and procedures. Conclusions Future research might better target employer practices by tying interventions to positive workplace influences and determinants, by developing more participatory interventions and research designs, and by designing interventions that address factors of organizational change.

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Project description:Tobacco consumption is a risk factor for chronic diseases and worldwide around six million people die from long-term exposure to first- or second-hand smoke annually. One effective approach to tobacco control is smoking cessation counseling by primary care physicians. However, research suggests that smoking cessation counseling is not sufficiently implemented in primary care. In order to understand and address the discrepancy between evidence and practice, an overview of counseling practices is needed. Therefore, the aim of this systematic literature review is to assess the frequency of smoking cessation counseling in primary care. Self-reported counseling behavior by physicians is categorized according to the 5A's strategy (ask, advise, assess, assist, arrange). An electronic database search was performed in Embase, Medline, PsycINFO, CINAHL and the Cochrane Library and overall, 3491 records were identified. After duplicates were removed, the title and abstracts of 2468 articles were screened for eligibility according to inclusion/exclusion criteria. The remaining 97 full-text articles reporting smoking cessation counseling by primary care physicians were assessed for eligibility. Eligible studies were those that measured physicians' self-reported smoking cessation counseling activities via questionnaire. Thirty-five articles were included in the final review (1 intervention and 34 cross-sectional studies). On average, behavior corresponding to the 5A's was reported by 65% of physicians for "Ask", 63% for "Advise", 36% for "Assess", 44% for "Assist", and 22% of physicians for "Arrange", although the measurement and reporting of each of these counseling practices varied across studies. Overall, the results indicate that the first strategies (ask, advise) were more frequently reported than the subsequent strategies (assess, assist, arrange). Moreover, there was considerable variation in the items used to assess counseling behaviour and developing a standardized instrument to assess the counseling strategies implemented in primary care would help to identify and address current gaps in practice.

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Dataset Information

Antibiotic resistance in primary care in Austria - a systematic review of scientific and grey literature.

Background

Methods

Results

Conclusion

Publications

Antibiotic resistance in primary care in Austria - a systematic review of scientific and grey literature.

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