Assessment of the quality of antibiotics prescription in a regional health system

Abstract

Objectives: The inappropriate and indiscriminate use of antibiotics is one of the main factors contributing to the onset of antimicrobial resistance. In 2007, the European Surveillance of Antimicrobial Consumption (ESAC) project established certain indicators to assess the quality of antibiotic use. We analysed the quality of antibiotic prescription in La Rioja (Spain) in 2017, using epidemiological (age, sex, seasonal nature) and financial variables (price of the antibiotic and income level).

Material and methods: Using data on monthly distributions of antibiotics (J01) through official prescriptions and prescriptions from medical insurance companies, we calculated the population rates for the number of prescriptions per 1000 inhabitants, as well as the values of 9 quality indicators (by antibiotic family, age group, sex and income), defined by ESAC, classifying the prescription quality as "very high", "high", "low" and "very low".

Results: The quality of antibiotic prescriptions in La Rioja in 2017 was "high" for antibiotics dispensed through official prescriptions (18.55 daily defined doses per 1000 inhabitants [DID]) and "low" for those dispensed through medical insurance companies (21.79 DID). When we included private prescriptions (26.02 DID), the quality was "very low", taking into account the margins indicated by ESAC. We detected high rates of prescription for broad-spectrum antibiotics for men older than 45 years, penicillins for women aged 25 to 39 years, quinolones for pensioners and cephalosporins for high-income patients.

Conclusions: The quality of antibiotic prescription is determined not only by epidemiological variables, such as age and sex, but also by financial variables, such as patient income and antibiotic price.

Keywords: Antibiotics; Antibióticos; Atención Primaria; Farmacoepidemiología; Patient identification card; Pharmacoepidemiology; Prescripción; Prescription; Primary care; Tarjeta sanitaria individual.