Protected: Qi16 – Antibiotics consumption in community

Denominator

• Number of inhabitants / 1,000

Numerator

• Number of dispensations of antibacterials for systemic use (ATC J01 excluding methenamine J01XX05) during the examined year

Exclusions (Numerator, denominator)

N/A

Notes

N/A

Sources of Data

• Population register
• Outpatient medication dispensations register

Purpose

• The quality indicator set is intended for comparison of effectiveness and/or safety aspects of prescribing across Nordic countries and subnational regions.
• Further comparisons across population subgroups (e.g., socioeconomic position, immigration background) can inform equity considerations.
• Further comparisons in relation to expenditures can inform efficiency considerations

Limitations

• The indicators in the set use medication dispensings and/or sales data as a proxy for appropriate prescribing and medication use. This is to allow comparisons using register data, which have the advantage of being readily available and comprehensive in terms of population coverage and over time (10–12).
• Register data are not without limitations. Medications may have been prescribed, but not collected from the pharmacy by the user. Collected medications may not have been (appropriately) used by the patient. Sales data may not be fully comparable across countries.
• Register data are collected primarily for other purposes than quality assessment. Thus, discontinuities over time due to, e.g., legislative changes and administrative reforms need to be acknowledged in the interpretation of the results.
• Indicators need to be updated regularly because clinical guidelines and the range of available medications change over time.
• ATC-codes are based on WHO Collaborating Centre for Drug Statistics Methodology ATC/DDD Index version 2024

Similar or related indicators in Nordic or European quality assessment

The Norwegian Directorate of Health (Helsedirektoratet) (13)

• Antibiotic consumption as the number of dispensed prescriptions from pharmacies / 1000 inhabitants

Swedish Association of Local Authorities and Regions & Folkhälsomyndigheten (FoHM) (14,15)

• Antibiotic consumption as the number of dispensed prescriptions from pharmacies / 1000 inhabitants

Set quality targets

• The Swedish strategic programme against antibiotic resistance (STRAMA)(1)
  • Outpatient total use of antibiotics (J01 excluding methenamine) should not exceed 250 prescriptions per 1,000 inhabitants per year

• The Norwegian national strategy target (Nasjonal strategi mot Antibiotikaresistens 2015–2020)(2):
  • Antibiotic consumption (DID) is reduced by 30% from 2012 level
  • Prescribing of antibiotics (J01 excluding methenamine) is reduced to 250 prescriptions per 1,000 inhabitants per year.
• The Danish National Action Plan for Antibiotics (16) for 2017–2020:
  • Reduction of primary care antibiotic prescribing (J01 + P01AB01) to 350 prescriptions dispensed per 1,000 inhabitants.

Similar or related indicators in international scientific literature

• Total antibiotic use in nursing homes = DDDs of antibiotics (J01) or number of antibiotic prescriptions (J01) / 100 resident-days (17).
• Number of users per 100 person-years (PYs) = a percentage interpreted as the number of children per 100 who use an antibiotic by year. Prevalence stratified in 1-year age categories (0 to <1 years etc.) and in broader age categories: 0 to <1 years, 1 to <5 years, 5 to <12 years and 12 to <18 years. Prevalence calculated at ATC 3rd (pharmacological subgroup J01) and 5th (active substance) levels. (18)

1. Strama. Svensk strategi mot antibiotikaresistens. Stramas mål för antibiotikaanvändning inom öppen vård. [cited 2024 May 2]. Available from: https://strama.se/strategiska-dokument/
2. Nasjonal strategi mot Antibiotikaresistens 2015-2020. [cited 2024 May 2] Available from: https://www.regjeringen.no/no/dokumentarkiv/regjeringen-solberg/andre-dokumenter/hod/2015/nasjonal-strategi-mot-antibiotikaresistens-2015-2020/id2424598/
3. Bronzwaer SLAM, Cars O, Buchholz U, Mölstad S, Goettsch W, Veldhuijzen IK, et al. The Relationship between Antimicrobial Use and Antimicrobial Resistance in Europe. Emerg Infect Dis. 2002 Mar;8(3):278–82.
4. Browne AJ, Chipeta MG, Haines-Woodhouse G, Kumaran EPA, Hamadani BHK, Zaraa S, et al. Global antibiotic consumption and usage in humans, 2000–18: a spatial modelling study. Lancet Planet Health. 2021 Dec 1;5(12):e893–904.
5. Coenen S, Ferech M, Haaijer-Ruskamp FM, Butler CC, Vander Stichele RH, Verheij TJM, et al. European Surveillance of Antimicrobial Consumption (ESAC): quality indicators for outpatient antibiotic use in Europe. Qual Saf Health Care. 2007 Dec;16(6):440–5.
6. Goossens H, Ferech M, Vander Stichele R, Elseviers M. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. The Lancet. 2005 Feb 12;365(9459):579–87.
7. Malhotra-Kumar S, Lammens C, Coenen S, Van Herck K, Goossens H. Effect of azithromycin and clarithromycin therapy on pharyngeal carriage of macrolide-resistant streptococci in healthy volunteers: a randomised, double-blind, placebo-controlled study. The Lancet. 2007 Feb 10;369(9560):482–90.
8. Council Recommendation on stepping up EU actions to combat antimicrobial resistance in a One Health approach 2023/C 220/01 [Internet]. 2023. Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32023H0622(01)
9. Healthcare Quality and Outcomes Indicators – OECD [Internet]. [cited 2024 Feb 29]. Available from: https://www.oecd.org/health/health-care-quality-outcomes-indicators.htm
10. Laugesen K, Ludvigsson JF, Schmidt M, Gissler M, Valdimarsdottir UA, Lunde A, et al. Nordic Health Registry-Based Research: A Review of Health Care Systems and Key Registries. Clin Epidemiol. 2021 Dec 31;13:533–54.
11. Furu K, Wettermark B, Andersen M, Martikainen JE, Almarsdottir AB, Sørensen HT. The Nordic countries as a cohort for pharmacoepidemiological research. Basic Clin Pharmacol Toxicol. 2010 Feb;106(2):86–94.
12. Rasmussen L, Wettermark B, Steinke D, Pottegård A. Core concepts in pharmacoepidemiology: Measures of drug utilization based on individual-level drug dispensing data. Pharmacoepidemiol Drug Saf. 2022;31(10):1015–26.
13. Helsedirektoratet [cited 2024 May 2]. Antibiotika – forbruk av resepter. Available from: https://www.helsedirektoratet.no/statistikk/kvalitetsindikatorer/legemidler/forekomst-av-antibiotikabehandling
14. Förekomst av antibiotikabehandling i öppen vård [cited 2024 May 2]. Available from: https://vardenisiffror.se/indikator/12b6c0f6-9014-4a9e-af75-49c95c498cb9?datefrom=2022-07-01&dateto=2022-12-31&gender&relatedmeasuresbyentry=keyword&relatedmeasuresbyid=lakemedelsbehandling&showtarget=false&units=18&units=09&units=04&units=23&units=14&units=19&units=17&units=10&units=21&units=25&units=05&units=07&units=12&units=03&units=20&units=24&units=13&units=01&units=08&units=06&units=22&units=se
15. Antibiotikaförsäljningen i Sverige. 2024 [cited 2024 May 2]. Available from: https://www.folkhalsomyndigheten.se/folkhalsorapportering-statistik/statistikdatabaser-och-visualisering/antibiotikastatistik/sverige/
16. Regeringen.dk [cited 2024 May 7]. National handlingsplan for antibiotika til mennesker. Available from: https://www.regeringen.dk/aktuelt/tidligere-publikationer/national-handlingsplan-for-antibiotika-til-mennesker/
17. Simon M, Pereira O, Hulscher MEJL, Schouten J, Thilly N, Pulcini C. Quantity Metrics and Proxy Indicators to Estimate the Volume and Appropriateness of Antibiotics Prescribed in French Nursing Homes: A Cross-sectional Observational Study Based on 2018 Reimbursement Data. Clin Infect Dis. 2021 May 15;72(10):e493–500.
18. de Bie S, Kaguelidou F, Verhamme KMC, De Ridder M, Picelli G, Straus SMJM, et al. Using Prescription Patterns in Primary Care to Derive New Quality Indicators for Childhood Community Antibiotic Prescribing. Pediatr Infect Dis J. 2016 Dec;35(12):1317–23.