European Surveillance of Antimicrobial Consumption (ESAC): Quality indicators for outpatient antibiotic use in Europe

Samuel Coenen, Matus Ferech, Flora M. Haaijer-Ruskamp, Chris C. Butler, Robert H. Vander Stichele, Theo J.M. Verheij, Dominique L. Monnet, Paul Little, Herman Goossens, Helmut Mittermayer, Sigrid Metz, Boyka Markova, Igor Francetic, Despo Bagatzouni, Annemette Anker Nielsen, Ly Rootslane, Pentti Huovinen, Pirkko Paakkari, Didier Guillemot, Winfried KernHelmut Schroeder, Helen Giamarellou, Anastasia Antoniadou, Gabor Ternak, Ria Benko, Karl Kristinsson, Robert Cunney, Ajay Oza, Raul Raz, Giuseppe Cornaglia, Robert Hemmer, Marcel Bruch, Michael Borg, Peter Zarb, Margreet Filius, Waleria Hryniewicz, Luis Caldeira, Irma Codita, Svetlana Ratchina, Viliam Foltan, Tomas Tesar, Edurne Lazaro, Francisco De Abajo, Otto Cars, Gunilla Skoog, Giuliano Masiero, Serhat Unal

Research output: Article

107 Citations (Scopus)


Background and objective: Indicators to measure the quality of healthcare are increasingly used by healthcare professionals and policy makers. In the context of increasing antimicrobial resistance, this study aimed to develop valid drug-specific quality indicators for outpatient antibiotic use in Europe, derived from European Surveillance of Antimicrobial Consumption (ESAC) data. Methods: 27 experts (15 countries), in a European Science Foundation workshop, built on the expertise within the European Drug Utilisation Research Group, the General Practice Respiratory Infections Network, the ESCMID Study Group on Primary Care Topics, the Belgian Antibiotic Policy Coordination Committee, the World Health Organization, ESAC, and other experts. A set of proposed indicators was developed using 1997-2003 ESAC data. Participants scored the relevance of each indicator to reducing antimicrobial resistance, patient health benefit, cost effectiveness and public health policy makers (scale: 1 (completely disagree) to 9 (completely agree)). The scores were processed according to the UCLA-RAND appropriateness method. Indicators were judged relevant if the median score was not in the 1-6 interval and if there was consensus (number of scores within the 1-3 interval was fewer than one third of the panel). From the relevant indicators providing overlapping information, the one with the highest scores was selected for the final set of quality indicators-values were updated with 2004 ESAC data. Results: 22 participants (12 countries) completed scoring of a set of 22 proposed indicators. Nine were rated as relevant antibiotic prescribing indicators on all four dimensions; five were rated as relevant if only relevance to reducing antimicrobial resistance and public health policy makers was taken into account. A final set of 12 indicators was selected. Conclusion: 12 of the proposed ESAC-based quality indicators for outpatient antibiotic use in Europe have face validity and are potentially applicable. These indicators could be used to better describe antibiotic use in ambulatory care and assess the quality of national antibiotic prescribing patterns in Europe.

Original languageEnglish
Pages (from-to)440-445
Number of pages6
JournalQuality and Safety in Health Care
Issue number6
Publication statusPublished - dec. 2007

ASJC Scopus subject areas

  • Health Policy

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    Coenen, S., Ferech, M., Haaijer-Ruskamp, F. M., Butler, C. C., Vander Stichele, R. H., Verheij, T. J. M., Monnet, D. L., Little, P., Goossens, H., Mittermayer, H., Metz, S., Markova, B., Francetic, I., Bagatzouni, D., Nielsen, A. A., Rootslane, L., Huovinen, P., Paakkari, P., Guillemot, D., ... Unal, S. (2007). European Surveillance of Antimicrobial Consumption (ESAC): Quality indicators for outpatient antibiotic use in Europe. Quality and Safety in Health Care, 16(6), 440-445.