Selection of proxy indicators estimating the appropriateness of antibiotic prescriptions in general practice: a national consensus procedure in France
Maïa Simon, Aurélie Bocquier, Ouarda Pereira, Alexandre Charmillon, Damien Gonthier, Florence Lieutier Colas, Camille Vallance, Adeline Welter, Céline Pulcini, Nathalie Thilly, Jacques Birgé, Jean-Marc Boivin, Willy Boutfol, Antoine Canton, Mourad Bourji Chergui, Sylvain Diamantis, Thibaut Fraisse, Olivier Hanriot, Philippe Hild, Elodie Imboula, Pascal Meyvaert, Patricia Pavese, François Pelissier, Hélène Romary, Léa Schleck, Caroline Valentin, Jean-Charles Vauthier, Mathieu Viellard,- Microbiology (medical)
- Infectious Diseases
- Immunology and Allergy
- Microbiology
- Immunology
Abstract
Background
GPs are responsible for more than 70% of outpatient antibiotic prescriptions in France. Metrics are important antibiotic stewardship tools that can be used to set targets for improvement and to give feedback to professionals and stakeholders.
Objectives
The primary objective of the present study was to select a set of proxy indicators (PIs) based on 10 previously developed PIs, to estimate the appropriateness of antibiotic prescriptions by GPs. The secondary objective was to evaluate the clinimetric properties of the selected PIs.
Methods
A RAND-modified Delphi consensus procedure was conducted with a multidisciplinary panel of stakeholders. This procedure consisted of two successive online surveys with a consensus meeting in between. Clinimetric properties (measurability, applicability and potential room for improvement) were evaluated for the PIs selected through the consensus procedure, using 2022 Regional Health Insurance data.
Results
Seventeen experts participated in the first-round survey and 14 in the second-round. A final set of 12 PIs was selected. Among the 10 initial PIs, 3 were selected without modification and 7 were modified and selected. Moreover, two newly suggested PIs were selected. Ten of the 12 PIs presented good clinimetric properties.
Conclusions
The 12 selected PIs cover the main situations responsible for inappropriate and unnecessary use of antibiotics in general practice. These PIs, easily calculable using routinely collected health insurance reimbursement data, might be used to give feedback to prescribers and stakeholders and help improve antibiotic prescriptions in primary care.