Long-lasting improvement in general practitioners' prescribing of antibiotics by means of medical audit

Objective - To evaluate the usefulness of medical audit of GPs' antibiotic prescription habits. Design - Medical audit according to the APO method. Registration of antibiotic prescriptions for respiratory tract infections during a 3 year period. Intervention with courses, visits to the laboratory, and distribution of recommendations concerning diagnosis and treatment of respiratory infections. Setting - 24 Danish GPs in cooperation with Audit Project Odense (APO) and Department of Clinical Microbiology, Odense University Hospital. 207 GPs acted as controls. Main outcome measures - Changes in the number of antibiotic prescriptions and in the penicillin/broad-spectrum antibiotic ratio. Results - The proportion of antibiotic prescriptions was reduced during the investigation period, but a similar reduction was found in the control groups. Only for acute sinusitis was a lasting decrease not found in the control groups recorded. The penicillin/broad-spectrum antibiotic ratio increased in the intervention group (1.33 in 1992, 1.94 in 1993 and 2.70 in 1995). This increase was significantly higher than in the control groups. The change was seen for acute sinusitis, bronchitis, and pneumonia, but not for acute otitis media or acute tonsillitis. The changes induced from 1992 to 1993 were maintained or increased from 1993 to 1995 although the educational measures had stopped. Conclusion - Medical audit according to the APO method is a useful tool for inducing and maintaining desirable changes in GPs' prescription habits.