Infectious diseases and use of antibiotics in primary care
The group aims to deliver high quality research that contributes to improve knowledge of infectious disease management, decrease inappropriate use of antibiotics, and control the development of antimicrobial resistance.
The dilemma during everyday practice:
“There is a patient expecting a solution to his/her problems. There is a GP expecting to be responsive to the needs of the patient. There is a system expecting a rational use of resources and contention of the antimicrobial resistance problem” Cordoba G, Llor C. BMJ Evidence-Based Medicine. doi: 10.1136/bmjebm-2018-111146
The research group is divided into the following subprojects:
5-year project in which economic theories will be used to design clinical interventions to reduce unnecessary prescription of antibiotics in General Practice. The project aims to identify predictors for the occurrence of antibiotic resistance and assess the effect of doctors' use of information on resistance and its predictors in the choice of prescription.
Study 1 considers the predictive power of rich, high-dimensional information about each individual for antibiotic resistance test results via methods out of the machine learning toolbox. Machine learning routines allow for simultaneous flexible model selection and estimation with high dimensional data.
Study 2 tackles the question of how general practitioners make use of diagnostic information in their treatment choices. We will investigate the role of physicians’ information sets at the point of treatment and diagnostic choices in a well-defined behavioral model.
Study 3 considers a mechanism that may be affected by regulatory interventions. The median general practice in Denmark is a single-physician practice. In the past ten years, however, a trend of practice consolidation is observable. This consolidation is likely not driven by antibiotic prescription choices of general practitioners. Therefore, this study aims to exploit the variation in practice size to learn about the impact of peer effects on antibiotic diagnostic and rescription choices.
- Hannes Ullrich, Associate professor German Institute for Economic Research
- Michael Allan Ribers, postdoc, Department of Economics – University of Copenhagen
Advisory board: N/A
Funding: European Research Counci
Project period: 2019-2023
PI: Hannes Ullrich
Contact person: Gloria Cordoba
Register-based study aimed at identifying the factors determining prescription of antibiotics among the elderly population in general practice in Denmark.
- Descriptive analysis of the prescription of antibiotics
- Assessment of factors associated with major consumers of antibiotics
- Assessment of the association between use of antibiotics and development of antimicrobial resistance.
Microbiology department, Herlev and Gentofte Hospitals
- Gloria Cordoba, assistant professor, University of Copenhagen
- Barbara Juliane Holzknecht, associate professor, University of Copenhagen
- Jette Nygaard, Researcher, Microbiology department, Herlev Hospital
- Rune Aabenhus, assistant professor, University of Copenhagen
- Lars Bjerrum, Professor, University of Copenhagen
Funding: Herlev Hospital
Project period: 2018-2021
PI: Lars Bjerrum
Contact person: Maria Louise Veimer
This project aims to improve treatment of urinary tract infections in nursing home residents by focusing on the nursing home staff´s role in the antibiotic prescribing pathway. The main objectives are to identify the problems in the collaboration between nursing homes and the GP, to develop a relevant intervention targeting the nursing home staff, and then to test and to evaluate the intervention. The project influences how urinary tract infections is diagnosed and treated in the nursing home setting.
Study 1: A qualitative study about collaboration, diagnostics and treatment: The study investigates how collaboration between the nursing home staff and the GPs work. In particular, it focuses on how diagnostics and treatment are affected by the many stakeholders in the prescribing pathway.
Study 2: Developing a tailored, complex intervention: This study explores how to develop and tailor a complex intervention aimed at the nursing home staff. The focus is on identifying barriers and facilitators of implementation.
Study 3: Testing the intervention in a cluster Randomised Controlled Trial (cRCT): The study tests the intervention in a cRCT in 22 nursing homes. The outcomes are antibiotic prescribing for UTI, hospitalization, mortality and appropriate prescribing.
Study 4: A qualitative evaluation of the intervention: The study evaluates the use and implementation of the intervention. We use semi-structured interviews with key informants from the participating nursing homes in study 3.
- Department of Clinical Microbiology, Herlev and Gentofte Hospitals
- Municipality of Gentofte
- Arnold S, Jensen JN, Kousgaard MB, Siersma V, Bjerrum L, Holm A
- Reducing Antibiotic Prescriptions for Urinary Tract Infection in Nursing Homes: A Protocol for a Cluster Randomized Controlled Trial with a Complex, Tailored Intervention Targeting Nursing Home Staff. DOI: 10.2196/17710
All data have been collected for all studies, and we are currently working on publication of the results.
- Marius Brostrøm Korsgaard, political scientist, CEFUAM, IFSV, University of Copenhagen
- Christian Schultz Hansen, economist, Section for Health Services Research, IFSV, University of Copenhagen
- Volkert Siersma, statistician CEFUAM, IFSV, University of Copenhagen
- Jon Trærup Andersen, Clinical Pharmacologist, Bispebjerg Hospital
- Municipality of Gentofte
- Kvalitet i almen praksis - Region Hovedstaden (KAP-H)
- Praksiskonsulenten, Gentofte kommune
- Multipraksisudvalget, Dansk selskab for almen medicin (DSAM) og Praktiserende lægers organisation (PLO)
Funding: The Danish Ministry of Health, The Velux Foundation, KEU Region H
Project period: 01-04-2017 – 01-01-2021
PI: Sif Helene Arnold
The purpose of the project is to improve health care management by guaranteeing secure access to effective antibiotics. Therefore, the main objective is to identify and prioritize the key “One Health” factors and interventions (i.e., prescription policies and optimal antibiotic use) that should be taken into consideration to ensure appropriate and effective antibiotic use within the Brazilian context. This new knowledge will, in turn, be used to support the progress of Brazil’s National Action Plan on antimicrobial resistance (AMR).
WP 1: The individual, the household, and the community – This WP will explore the views of users of the healthcare system, including those co-habiting with pets about appropriate use of antibiotics, risk of AMR and “One Health” habits of family and pet interactions.
WP2: The prescribers or providers (primary health care, secondary care, pharmacist, veterinarian) – This WP will explore how prescribers handle the treatment decision, the agency duties of prescribers and providers of antibiotics, and strategies that patients/pet owners use to request or reject the use of antibiotics.
WP 3: Public and private stakeholders (multi-level governance) - will explore public and private stakeholders’ perceptions on AMR and intersectorial work at the national level.
- University of Sao Paulo
- Federal University of Rio de Janeiro
- University of Paraiba
- Solsten Diagnostica
- Sao Paulo Health Authorities - Denisse Brando de Assis
- Albert Einstein Hospital - Denise Maria Campos de Lima Castro
- International Center for Antimicrobial Resistance Solutions (ICARS) – Robert Skov
- Danish Consulate in Brazil – Tina Gottlieb
- Danish embassy in Brazil – Brit Borum Madsen
Project period: 01-03-2020 – 28-02-2022
PI: Gloria Cordoba
The HAPPY PATIENT project aims at reducing the inappropriate use and dispensing of antibiotics in the most common community-acquired infections (i.e., respiratory tract infections, urinary tract infections, dental infections) with a multifaceted intervention in health care facilities as suggested in point 4.2 of the EU guidelines for the prudent use of antimicrobials in human health. The multifaceted intervention will be carried out in five countries with a diverse pattern of antibiotic consumption: ES, FR, LT, PL and GR.
We will follow a model which both promotes both stakeholder stewardship and is patient-centred. The critical focus will be on the most important interaction in determining usage of antibiotics: contact between patients and health professionals at different levels of the Health Care System. Hence, activities of HAPPY PATIENT will target patients, primary care professionals (general practitioners, nurses, and dentists), secondary care (out-of-hours services), nursing homes and community pharmacists.
We will follow the Audit Project Odense (APO) methodology developed in FP6 HAPPY AUDIT project. APO consists of an audit-based registration to perform a context analysis before the implementation of the multifaceted intervention, and then to perform an assessment of changes after the implementation of the multifaceted intervention.
Based on the Normalization Process Theory for changing behaviour, the multifaceted intervention will include: a) peer feedback with reflexion and discussion, b) enhancement of communication skills in order to improve the communication process between the health professionals and the patients, c) patient information leaflets and posters, d) country-tailored information on antibiotic usage(incl. the “antibiotic foot-print”).
- Institut Català de la Salut
- Research Unit for General Practice Odense
- NORCE Norwegian Research Centre AS
- The Capital Region of Denmark
- EuroDURG European Drug Utilisation Group
- University of Las Palmas de Gran Canaria
- Nice University Hospital
- Ltd Mano Seimos Gydytojas
- Medical University of Lodz
- Spanish Society for Family and Community Medicine
- University of Crete
- European Association for Clinical Pharmacology
- University Institute for Patient Care
- WONCA Europe
Advisory board: N/A
Funding: European Commission, 3rd Health Programme
Project period: 2020 - 2023
PI: Carl Llor
Contact person: Gloria Cordoba
Antimicrobial resistance is considered as one of the most important public health problems in the world. Elderly patients constitute a group of patients that in particular are vulnerable to infections with resistant bacteria. In Denmark, antibiotic prescribed to elderly patients in general practice has increased significantly over the past 10 years, with acute urinary tract infections (UTI) being the most common indication.
The purpose of the project is to improve the quality of the diagnostic process and antibiotic treatment of adult patients with suspected UTI in Danish general practice. Therefore, the main objective is to investigate areas in need of quality improvement within the diagnostic process and antibiotic treatment of patients > 18 years, with particular focus on elderly patients (> 65 years), with suspected UTI in general practice.
- Participating general practices will register for each patient with suspected UTI the following information on an audit registration chart: symptoms, findings, use of tests (urinary dipstick, microscopy, culture) and type of antibiotics given if any.
- The knowledge from analyzing the registration data in general practice will be used to create an intervention program including reflection of management, discussion, benchmarking, education etc.
- Research Unit for General Practice, Department of Clinical Medicine, Aalborg University, Denmark
- Audit Project Odense, Research Unit of General Practice, University of Southern Denmark
Funding: KEU-the Capital Region of Copenhagen and Fonden for Almen Praksis
Project period: 01-03-2019 – 28-02-2021
PI: Lars Bjerrum
|Aabenhus, Rune Munck||Assistant professor||+45 353-37302|
|Bjerrum, Lars||Professor||+45 353-27939|
|Cordoba Currea, Gloria Cristina||Assistant professor|
|Holm, Anne||Visiting Researcher|
|Jensen, Maria Louise Veimer||Student|
|Olesen, Julie Aamand||Academic assistant||+45 353-36040|
|Saust, Laura Trolle||Assistant lecturer||+45 353-31052|