Title: Prescription behavior regarding antibiotics for respiratory infections in nursing homes in Zeeland; Evidence based or value based?

Biography:

Wendy Lorier has completed her MSc at the age of 28 years from Fontys University of Applied Sciences, Tilburg. She works as a nurse practitioner in a nursing home. She did her master thesis about prescription behavior regarding antibiotics for respiratory infections in nursing homes in The Netherlands.

Abstract

Aim: Gaining insight into the prescription behaviour of healthcare professionals who work in nursing homes of SVRZ in Zeeland, regarding the prescription of antibiotics for respiratory infections.

 Background: These days, pneumonia is the number two most common infectious disease in nursing homes in the Netherlands, after urinary tract infections, and is associated with high numbers of mortality and morbidity.

Design: A mixed method design was used comprising a retrospective file research and a focus group. The antibiotics recipes prescribed from September 2016 to September 2017, where mapped from the files. After that, a focus group consisting of eight healthcare professionals reflected on the possibilities of adjusting prescription policy.

Results: In total 498 recipes with notice of respiratory infections were found, with 11 different sorts of antibiotics prescribed. Thereof, 63, 6% was prescribed according to the NHG guideline ‘acute coughing’ and 36, 4% was not. During the focus group, consensus was reached about appropriate antibiotics for complicated respiratory infections in elderly (amoxillin/clav acid, ceftriaxon, amoxillin, and trimethoprim/sulfamethoxazol). At the same time, the focus group provided insights in the reasons for non-adherence to the NHG guidline, with clinical deterioration as the most decisive symptom to start antibiotics.

Conclusion: The results of this study show that healthcare professionals in nursing homes prescribe a variation of antibiotics which are not completely in line with the NHG guideline. Considerations regarding prescription behaviour are influenced by characterisations of vulnerability of elderly people, ‘the clinical view’ and values with regard to meaningful care.