Arnoldas Jurgutis

Health Alliance for prudent antibiotic prescribing in patients with respiratory tract infections (HAPPY AUDIT) -impact of a non-randomised multifaceted intervention programme

BackgroundExcessive use of antibiotics is worldwide the most important reason for development of antimicrobial resistance. As antibiotic resistance may spread across borders, high prevalence countries may serve as a source of bacterial resistance for countries with a low prevalence. Therefore, bacterial resistance is an important issue with a potential serious impact on all countries. Initiatives have been taken to improve the quality of antibiotic prescribing in primary care, but only few studies have been designed to determine the effectiveness of multifaceted strategies across countries with different practice setting. The aim of this study was to evaluate the impact of a multifaceted intervention targeting general practitioners (GPs) and patients in six countries with different health organization and different prevalence of antibiotic resistance.MethodsGPs from two Nordic countries, two Baltic Countries and two Hispano-American countries registered patients with respiratory tract infections (RTIs) in 2008 and 2009. After first registration they received individual prescriber feedback and they were offered an intervention programme that included training courses, clinical guidelines, posters for waiting rooms, patient brochures and access to point of care tests (Strep A and C-Reactive Protein). Antibiotic prescribing rates were compared before and after the intervention.ResultsA total of 440 GPs registered 47011 consultations; 24436 before the intervention (2008) and 22575 after the intervention (2009). After the intervention, the GPs significantly reduced the percentage of consultations resulting in an antibiotic prescription. In patients with lower RTI the GPs in Lithuania reduced the prescribing rate by 42%, in Russia by 25%, in Spain by 25%, and in Argentina by 9%. In patients with upper RTIs, the corresponding reductions in the antibiotic prescribing rates were in Lithania 20%, in Russia 15%, in Spain 9%, and in Argentina 5%.ConclusionA multifaceted intervention programme targeting GPs and patients and focusing on improving diagnostic procedures in patients with RTIs may lead to a marked reduction in antibiotic prescribing. The pragmatic before-after design used may suffer from some limitations and the reduction in antibiotic prescribing could be influenced by factors not related to the intervention.

Differences in referral rates to specialised health care from four primary health care models in Klaipeda, Lithuania

BackgroundLithuanian primary health care (PHC) is undergoing changes from the systems prevalent under the Soviet Union, which ensured free access to specialised health care. Currently four different PHC models work in parallel, which offers the opportunity to study their respective effect on referral rates. Our aim was to investigate whether there were differences in referrals rates from different Lithuanian PHC models in Klaipeda after adjustment for co-morbidity.MethodsThe population listed with 18 PHC practices serving inhabitants in Klaipeda city and region (250 070 inhabitants). Four PHC models: rural state-owned family medicine practices, urban privately owned family medicine practices, state-owned polyclinics and privately owned polyclinics. Information on listed patients and referrals during 2005 from each PHC practice in Klaipeda was obtained from the Lithuanian State Sickness Fund database. The database records included information on age, gender, PHC model, referrals and ICD 10 diagnoses. The Johns Hopkins ACG Case-Mix system was used to study co-morbidity. Referral rates from different PHC models were studied using Poisson regression models.ResultsPatients listed with rural state-owned family medicine practices had a significantly lower referral rate to specialised health care than those in the other three PHC models. An increasing co-morbidity level correlated with a higher physician- to self-referral ratio.ConclusionFamily medicine practices located in rural-, but not in urban areas had significantly lower referral rates to specialised health care. It could not be established whether this was due to organisation, training of physicians or financing, but suggests there is room for improving primary health care in urban areas. Patients place of residence and co morbidity level were the most important factors for referral rate. We also found that gatekeeping had an effect on the referral pattern with respect to co-morbidity level, so that those with a physician referral were more likely to have had higher co-morbidity.

Enabling factors for antibiotic prescribing for upper respiratory tract infections: Perspectives of Lithuanian and Russian general practitioners

Abstract Introduction. General practitioners (GPs) write about 80% of all antibiotic prescriptions, the greatest number of them for patients with respiratory tract infections. However, there is a lack of research targeting the influence of external factors on antibiotic prescribing by physicians. This study aimed to explore experiences of GPs in Lithuania and the Russian Federation with regard to antibiotic prescription for upper respiratory tract infections. By such means it might be possible to reveal external enabling factors that influence antibiotic prescribing in these countries. Method. Five focus groups were performed with 22 GPs from Lithuania and 29 GPs from the Kaliningrad Region of the Russian Federation; then, thematic analysis of data was performed. Results. Six thematic categories were identified that are related to external forces enabling antibiotic prescription: the necessity for political leadership to encourage clinically grounded antibiotic use; over-the-counter sale of antibiotics; designation of antibiotics as reimbursable medications; supervision by external oversight institutions; lack of guidelines for the treatment of upper respiratory tract infections; and pharmaceutical company activities. Conclusions. Comprehensive efforts to reduce the burden of non-clinically grounded antibiotic prescription should go beyond addressing factors at the physician–patient level and take into account important factors in the enabling environment as well.

A study of antibiotic prescribing: the experience of Lithuanian and Russian GPs

Background. Globally, general practitioners (GPs) write more than 90% of all antibiotic prescriptions. This study examines the experiences of Lithuanian and Russian GPs in antibiotic prescription for upper respiratory tract infections, including their perceptions of when it is not indicated clinically or pharmacologically. Methods. 22 Lithuanian and 29 Russian GPs participated in five focus group discussions. Thematic analysis was used to analyse the data. Results. We identified four main thematic categories: patients’ faith in antibiotics as medication for upper respiratory tract infections; patient potential to influence a GP’s decision to prescribe antibiotics for upper respiratory tract infections; impediments perceived by GPs in advocating clinically grounded antibiotic prescribing with their patients, and strategies applied in physician-patient negotiation about antibiotic prescribing for upper respiratory tract infections. Conclusions. Understanding the nature of physician-patient interaction is critical to the effective pursuit of clinically grounded antibiotic use as this study undertaken in Lithuania and the Russian Federation has shown. Both physicians and patients must be targeted to ensure correct antibiotic use. Further, GPs should be supported in enhancing their communication skills about antibiotic use with their patients and encouraged to implement a shared decision-making model in their practices.

Family medicine in the Baltic countries

In this journal, we regularly publish national editorials from the five Nordic colleges of general practitioners [1–5], as an important way of learning from each other. Just as important, is, of course, to learn from other countries, and the aim of this editorial is to give an overview of family medicine in Estonia, Latvia, and Lithuania.

Patients’ Appearance And Body Image Problems: The Experience And Competence Of Health Care Specialists

Santrauka Žmogaus kūno išvaizda ir jo įvaizdis visuomenėje yra vienos aktualiausių nūdienos visuomenės sveikatos temų. Darbo tikslas – išanalizuoti sveikatos specialistų patirtį gydant pacientus, turinčius išvaizdos ir kūno įvaizdžio problemų bei jų kompetencijos didinimo poreikius. Kokybiniame tyrime, atliktame grupinės diskusijos metodu, dalyvavo 13 asmenų, kurių didžiąją dalį sudarė tiesiogiai su pacientais, klientais dirbantys sveikatos specialistai – jų buvo 10 (gydytojai, slaugytojai, visuomenės sveikatos specialistai). Duomenų analizei buvo taikomas kokybinės turinio analizės metodas. Analizė buvo atliekama šiais etapais: transkribuotų įrašų skaitymas ir duomenų segmentų išskyrimas, kategorizavimas pagal interviu plano blokus bei duomenų interpretavimas. Analizuojant informantų patirtis dėl darbo su pacientais, turinčiais išvaizdos ir kūno įvaizdžio problemų, nustatyta, jog tiek slaugytojai, tiek gydytojai turi nepakankamai žinių, gebėjimų ir patirties ir laiko konsultuoti pacientus dėl jų išvaizdos ar įvaizdžio. Reikalingos papildomos žinios problemos identifikavimui, gebėjimui tai daryti atskirose amžiaus grupėse. Be to, stokojama psichologinio konsultavimo žinių bei žinių darbui su vaikais dėl jų išvaizdos. Tyrimo dalyvių nuomone, tikslingiausias būtų kompleksinis mokymas apie pacientų, turinčių išvaizdos ir kūno įvaizdžio problemų, gydymą.