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Quality assessment of diagnosis and antibiotic treatment of infectious diseases in primary care: a systematic review of quality indicators

View Article: PubMed Central - PubMed

ABSTRACT

Objective: To identify existing quality indicators (QIs) for diagnosis and antibiotic treatment of patients with infectious diseases in primary care.

Design: A systematic literature search was performed in PubMed and EMBASE. We included studies with a description of the development of QIs for diagnosis and antibiotic use in patients with infectious diseases in primary care. We extracted information about (1) type of infection; (2) target for quality assessment; (3) methodology used for developing the QIs; and (4) whether the QIs were developed for a national or international application. The QIs were organised into three categories: (1) QIs focusing on the diagnostic process; (2) QIs focusing on the decision to prescribe antibiotics; and (3) QIs concerning the choice of antibiotics.

Results: Eleven studies were included in this review and a total of 130 QIs were identified. The majority (72%) of the QIs were focusing on choice of antibiotics, 22% concerned the decision to prescribe antibiotics, and few (6%) concerned the diagnostic process. Most QIs were either related to respiratory tract infections or not related to any type of infection. A consensus method (mainly the Delphi technique), based on either a literature study or national guidelines, was used for the development of QIs in all of the studies.

Conclusions: The small number of existing QIs predominantly focuses on the choice of antibiotics and is often drug-specific. There is a remarkable lack of diagnostic QIs. Future development of new QIs, especially disease-specific QIs concerning the diagnostic process, is needed.

Key points: In order to improve the use of antibiotics in primary care, measurable instruments, such as quality indicators, are needed to assess the quality of care being provided.

Key points: A total of 11 studies were found, including 130 quality indicators for diagnosis and antibiotic treatment of infectious diseases in primary care.

Key points: The majority of the identified quality indicators were focusing on the choice of antibiotics and only a few concerned the diagnostic process.

Key points: All quality indicators were developed by means of a consensus method and were often based on literature studies or guidelines.

Key points: All quality indicators were developed by means of a consensus method and were often based on literature studies or guidelines.

No MeSH data available.


Flow diagram summary of selection process.
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Figure 0001: Flow diagram summary of selection process.

Mentions: The literature search identified 1787 potential studies. Another seven studies meeting the criteria for inclusion were identified after searching references of retrieved papers. After adjusting for duplicates, 1752 remained. A total of 1408 was excluded by title and 238 after reading the abstract. Fifteen were excluded based on language (Spanish, French, Hungarian, and German). A total of 91 articles were read in full text, and 80 of them were excluded because they either: did not use QIs to assess quality of care (n = 12); did not report on QIs for infectious diseases (n = 6); only had a description of methods for development of QIs (n = 5); only concerned QIs for use in hospital settings (n = 4); only dealt with quality improvement of antibiotic use in general (n = 25); were conference abstracts (n = 6); described the application of existing QIs (n = 21) or developed standards for existing QIs (n = 1). The selection process resulted in a total of 11 studies fulfilling the criteria for the synthesis of this review (Figure 1).


Quality assessment of diagnosis and antibiotic treatment of infectious diseases in primary care: a systematic review of quality indicators
Flow diagram summary of selection process.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5036015&req=5

Figure 0001: Flow diagram summary of selection process.
Mentions: The literature search identified 1787 potential studies. Another seven studies meeting the criteria for inclusion were identified after searching references of retrieved papers. After adjusting for duplicates, 1752 remained. A total of 1408 was excluded by title and 238 after reading the abstract. Fifteen were excluded based on language (Spanish, French, Hungarian, and German). A total of 91 articles were read in full text, and 80 of them were excluded because they either: did not use QIs to assess quality of care (n = 12); did not report on QIs for infectious diseases (n = 6); only had a description of methods for development of QIs (n = 5); only concerned QIs for use in hospital settings (n = 4); only dealt with quality improvement of antibiotic use in general (n = 25); were conference abstracts (n = 6); described the application of existing QIs (n = 21) or developed standards for existing QIs (n = 1). The selection process resulted in a total of 11 studies fulfilling the criteria for the synthesis of this review (Figure 1).

View Article: PubMed Central - PubMed

ABSTRACT

Objective: To identify existing quality indicators (QIs) for diagnosis and antibiotic treatment of patients with infectious diseases in primary care.

Design: A systematic literature search was performed in PubMed and EMBASE. We included studies with a description of the development of QIs for diagnosis and antibiotic use in patients with infectious diseases in primary care. We extracted information about (1) type of infection; (2) target for quality assessment; (3) methodology used for developing the QIs; and (4) whether the QIs were developed for a national or international application. The QIs were organised into three categories: (1) QIs focusing on the diagnostic process; (2) QIs focusing on the decision to prescribe antibiotics; and (3) QIs concerning the choice of antibiotics.

Results: Eleven studies were included in this review and a total of 130 QIs were identified. The majority (72%) of the QIs were focusing on choice of antibiotics, 22% concerned the decision to prescribe antibiotics, and few (6%) concerned the diagnostic process. Most QIs were either related to respiratory tract infections or not related to any type of infection. A consensus method (mainly the Delphi technique), based on either a literature study or national guidelines, was used for the development of QIs in all of the studies.

Conclusions: The small number of existing QIs predominantly focuses on the choice of antibiotics and is often drug-specific. There is a remarkable lack of diagnostic QIs. Future development of new QIs, especially disease-specific QIs concerning the diagnostic process, is needed.

Key points: In order to improve the use of antibiotics in primary care, measurable instruments, such as quality indicators, are needed to assess the quality of care being provided.

Key points: A total of 11 studies were found, including 130 quality indicators for diagnosis and antibiotic treatment of infectious diseases in primary care.

Key points: The majority of the identified quality indicators were focusing on the choice of antibiotics and only a few concerned the diagnostic process.

Key points: All quality indicators were developed by means of a consensus method and were often based on literature studies or guidelines.

Key points: All quality indicators were developed by means of a consensus method and were often based on literature studies or guidelines.

No MeSH data available.