Prescription of Antibiotics in pRimary CAre; a focus on immigrant communities in Rotterdam (PARCA)

The overarching aim of the PARCA study was therefore to reduce the incorrect prescription of antibiotics for migrants by general practitioners in primary care. 

The PARCA study consisted of three parts: 

1. Drawing up neighborhood profiles in Rotterdam. 

Results: For the 14 areas in Rotterdam, we have provided insight into the number of antibiotic prescriptions and what the characteristic determinants of those areas are. Three Rotterdam areas, Delfshaven, Feijenoord and Charlois, consistently stand out above the other areas; the number of antibiotics prescriptions is highest here. Most (non-Western) migrants live in these areas, the inhabitants on average have a lower SES score, and the standardized income is lower than in the other areas. 

2. A qualitative study among (a) different population groups (migrants and persons with a Dutch background) with the inclusion criteria: 18 years or older and being able to express yourself verbatim; and (b) general practitioners/pharmacists with the inclusion criteria: working within a practice/pharmacy in Rotterdam. 

Results: We conducted interviews with 10 GPs and 5 pharmacists and organized 10 focus group discussions (FGDs) with migrant groups and Dutch people without a migration background (65 people in total). GPs often experience difficult situations when prescribing. antibiotics to migrants due to language barriers. Incorrect prescription of antibiotics occurs in patient groups seen by the GP as vulnerable, such as in patients with a migration background or low SES. FGDs participants were reluctant to use antibiotics. Differences within groups, in attitude, experience and knowledge about antibiotics, were greater than differences between groups. 

3. The evaluation, by means of a controlled pre-post study, of a tailor-made intervention for general practitioners and their patients with a migration background. We obtained the data for this via the Dutch Foundation for Pharmaceutical Statistics. For the effect evaluation, we only included data from general practitioners who used their individual ‘Unique Healthcare Insurer Identification Code’. 

Results: Based on the insights gained from the FGDs and interviews, we have developed a communication intervention for general practitioners and their patients with a migration background. The intervention components (live training, E-learning and patient information about antibiotics) are publicly available via the website of Thuisarts.nl and Pharos.nl. The intervention has been evaluated in a controlled pre-post-study. There was an improvement in the knowledge and skills of GPs. However, we were unable to demonstrate a direct effect on antibiotic prescribing behaviour of general practitioners. Important limitations of our study are that we were unable to randomize the participating GPs, that we were unable to collect data on the number of registered patients per GP, and that we had no data on relevant patient characteristics. 

Erasmus MC, the GGD Rotterdam-Rijnmond, and Pharos conducted this research together.

The following limitations may have affected the results of this study:

• The researchers could not randomly assign the participating general practitioners to the intervention and the control group.
• They could not collect data on the number of registered patients per general practitioner.
• No data were available on relevant patient characteristics.
• The antibiotic prescribing behavior of general practitioners was influenced by the COVID-19 pandemic. General practitioners significantly reduced their prescribing of antibiotics during and after the pandemic.

During our study, the COVID-19 pandemic had a major influence on the antibiotic prescribing behavior of general practitioners; GPs started to prescribe significantly fewer antibiotics during and after the pandemic. This may have affected our results. 

Continuous attention to communication skills is important, just like support from the entire practice.