Impact of a multifaceted intervention programme on antibiotic prescribing in out-of-hours primary care in five European countries: secondary analyses of the HAPPY PATIENT project.

Background: Antimicrobial resistance is a major global health threat, driven mainly by excessive and inappropriate antibiotic use. As most antibiotics are prescribed outside hospitals, primary care measures are crucial for reducing use. The study aimed to investigate diagnostic coding and antibiotic prescribing for respiratory tract (RTI) and urinary tract (UTI) infections treated in out-of-hours clinics before and after a multifaceted intervention. Methods: Audit and feedback with analyses of prescription data from five out-of-hours clinics in Europe before and after a multifaceted intervention. The intervention consisted of an audit with reports and feedback to the prescriber, participation in workshops, communication and e-learning courses, and distribution of information materials to patients. Results: A total of 67 physicians recorded 1786 cases in the first period and 1820 in the second. Common cold/influenza was the most frequent diagnosis, increasing from 19.4% (95% CI 18-21) in the first to 28.7% (95% CI 27-31) in the second period. COVID-19 declined by 65.7% ( Conclusions: The study provided important insights into which RTIs are potentially inappropriately treated with antibiotics, although the intervention did not produce a statistically significant reduction in antibiotic prescribing. Positively, the use of first-line antibiotics for UTIs increased significantly.