Objectives

Scientific and technological objectives
In pursuit of the aim of CHAMP to implement a more evidence-based use of antibiotics by changing behaviour in of both medical professionals and the public, the scientific and technological objectives of CHAMP are: 

1. To obtain insight in management of lower respiratory tract infections and selected other common infections (otitis media, sinusitis, pharyngitis, bronchitis and urinary tract infections ) in Europe and to achieve a better understanding of (cultural) variation in management of these infections.
This project aims to make an inventory and a comparison of existing ways of management of infections throughout the European Union by linking the results of these projects by linking them to the date of existing European initiatives on prudent use such as GRACE (www.grace-lrti.org) and ESAC (www.ua.ac.be/esac). In pursuit of research objective one the following activities/sub-objectives are foreseen:

  1. To give an overview and comparison of current use of antibiotics in outpatients in Europe by using data from ESAC and GRACE;
  2. To link current antibiotic use in different European countries to valid quality indicators;
  3. To link current antibiotic use to attitudes and views of both medical professionals and patients in primary care in Europe and to illness behaviour of patients.

 

2. To obtain insight in the (cost)effectiveness of media campaigns aimed at changing behaviour towards more prudent use of antibiotics
Different campaigns have been started throughout the European Union, all of them at a national level. The results of these campaigns vary considerably. There are no good quantitative and qualitative indicators that provide for an objective view of the impact of these campaigns. CHAMP aims to make an inventory and a comparison of existing campaigns throughout the European Union. In order to develop tools for successful campaigns at the best value for money we will also study the cost effectiveness of the public campaigns. In pursuit of research objective two the following activities/sub-objectives are foreseen:

  1. To perform a systematic review and comparison of public campaigns aimed at the general public and health professionals in general on improving antibiotic use and on uptake of vaccination strategies in high-income countries (Europe, America, Asia, Australia);
  2. To model the cost-effectiveness of both public campaigns aiming at a rational antibiotic use and improvement of uptake of vaccinations;
  3. To generate economic evidence to inform policy and practice about tools to change the behaviour of the general public and professionals with regard to unnecessary antibiotic use.

 

3. To obtain insight in the (cost)effectiveness of behavioural programs aimed at a more evidence-based use of antibiotics by medical professionals and specific groups of patients.
In 2005 a systematic review showed that most interventions aimed at optimising prescribing antibiotics for acute respiratory tract infections were effective. (Welschen et al) The authors of the review found that the studies were of relatively low quality and the variety of methods used did not allow for conclusions on the effectiveness of the different interventions. Similar findings were reported by Arnold and Straus in their review on interventions to improve antibiotic use in ambulatory care. (Arnold, Straus 2006) Furthermore, most of these studies were performed on a national level, and did use mere antibiotic prescription rates as outcome measure, without looking at the quality of antibiotic use, i.e the rate of over-and underprescription. Quality benchmarks like evidence based prescription rates, variation of use over seasons and number of different types of antibiotics prescribed are not yet employed in quality assurance programs.
The reviews mentioned above did not include studies published during the last three years and papers on pragmatic studies without comparison with controls. In pursuit of research objective three the following activities/sub-objectives are foreseen:

  1. To combine recent evidence and data from non-experimental projects with the existing reviews on behavioural programs aiming at a more evidence-based use of antibiotics by medical professionals in primary care;
  2. To model the cost-effectiveness of interventions aiming at a more evidence-based use of antibiotics in primary care.

 

4. To review current guidelines on antimicrobial therapy of respiratory tract infections in European primary care
To enable the development of tools to improve antibiotic use in European primary care, it is necessary to have an overview of the different guidelines in this field in the different member states. Guidelines reflect the available evidence, but also show how local experts have interpreted this evidence and what management is regarded as feasible for the users of those guidelines. Partners who participate in this proposal are authors of both national and international guidelines. They have noted considerable differences across Europe in the interpretation of available evidence on the effectiveness of antibiotics. Reviewing guidelines in this field and analysis of differences between guidelines therefore is very important in the process of development of European strategies to rationalise antibiotic use.  In pursuit of research objective one the following activities/sub-objectives are foreseen:

  1. To review guidelines from European member states and, when applicable, international European guidelines on antimicrobial therapy of otitis media, sinusitis, acute sore throat and acute bronchitis.
  2. To analyse differences between guidelines mentioned under -1- and between European guidelines and guidelines from North America and Australia on the same topics. 

 

5. To review existing educational programs on antimicrobial therapy in respiratory tract infections for medical students and trainees in general practice
Strategies to implement evidence based use of antibiotics should start by appropriate training of medical students and trainees in vocational training programs. To our knowledge, until now no comprehensive overview of educational programs, used in European medical school and other training programs was made. An analysis of differences and teaching methods that could be used in other countries could be of great value for the development of a European policy to ensure a prudent use of antibiotics by young doctors in the near future. In pursuit of research objective five the following activities/sub-objectives are foreseen:

  1. To gather information from the 11 countries participating in the GRACE project on educational programs from medical schools and vocational programs in primary care on antibiotic therapy in respiratory tract infections
  2. To analyse this information and compare contents and methods used in the different member states

 

6. To develop tools for effective behavioural changes towards a more prudent use of anti-microbial agents
Based on the activities that will be carried out under research objectives 1, to 5, CHAMP aims to develop tools for influencing behaviour aimed at a prudent use of antimicrobials, better uptake of immunisation programs and a more rational illness behaviour. The information that is gathered in the other work packages has to be integrated and priorities have to be made. One of the most important challenges will be to develop generic tools that can be used throughout Europe but that can be adapted according to regional differences in perception of illness and appreciation of health care. In pursuit of research objective six, the following activities/sub-objectives are foreseen:

  1. To compare effectiveness and cost-effectiveness of public campaigns and behavioural programs aiming at the evidence based use of antibiotics.
  2. To study the relation between views and attitudes and patients and doctors towards respiratory tract infections, preventive measurements and antimicrobial therapy on the one hand and the effects of behavioural programs and public campaigns on the other hand.
  3. To reach consensus among experts on tools to improve the behaviour of medical professionals and the public concerning prevention and management of infectious diseases and antibiotic use.
  4. To explore the feasibility of behavioural programs in daily practice in different European settings.

Scientific and technological objectives
In pursuit of the aim of CHAMP to implement a more evidence-based use of antibiotics by changing behaviour in of both medical professionals and the public, the scientific and technological objectives of CHAMP are: 

1. To obtain insight in management of lower respiratory tract infections and selected other common infections (otitis media, sinusitis, pharyngitis, bronchitis and urinary tract infections ) in Europe and to achieve a better understanding of (cultural) variation in management of these infections.
This project aims to make an inventory and a comparison of existing ways of management of infections throughout the European Union by linking the results of these projects by linking them to the date of existing European initiatives on prudent use such as GRACE (www.grace-lrti.org) and ESAC (www.ua.ac.be/esac). In pursuit of research objective one the following activities/sub-objectives are foreseen:

  1. To give an overview and comparison of current use of antibiotics in outpatients in Europe by using data from ESAC and GRACE;
  2. To link current antibiotic use in different European countries to valid quality indicators;
  3. To link current antibiotic use to attitudes and views of both medical professionals and patients in primary care in Europe and to illness behaviour of patients.

 

2. To obtain insight in the (cost)effectiveness of media campaigns aimed at changing behaviour towards more prudent use of antibiotics
Different campaigns have been started throughout the European Union, all of them at a national level. The results of these campaigns vary considerably. There are no good quantitative and qualitative indicators that provide for an objective view of the impact of these campaigns. CHAMP aims to make an inventory and a comparison of existing campaigns throughout the European Union. In order to develop tools for successful campaigns at the best value for money we will also study the cost effectiveness of the public campaigns. In pursuit of research objective two the following activities/sub-objectives are foreseen:

  1. To perform a systematic review and comparison of public campaigns aimed at the general public and health professionals in general on improving antibiotic use and on uptake of vaccination strategies in high-income countries (Europe, America, Asia, Australia);
  2. To model the cost-effectiveness of both public campaigns aiming at a rational antibiotic use and improvement of uptake of vaccinations;
  3. To generate economic evidence to inform policy and practice about tools to change the behaviour of the general public and professionals with regard to unnecessary antibiotic use.

 

3. To obtain insight in the (cost)effectiveness of behavioural programs aimed at a more evidence-based use of antibiotics by medical professionals and specific groups of patients.
In 2005 a systematic review showed that most interventions aimed at optimising prescribing antibiotics for acute respiratory tract infections were effective. (Welschen et al) The authors of the review found that the studies were of relatively low quality and the variety of methods used did not allow for conclusions on the effectiveness of the different interventions. Similar findings were reported by Arnold and Straus in their review on interventions to improve antibiotic use in ambulatory care. (Arnold, Straus 2006) Furthermore, most of these studies were performed on a national level, and did use mere antibiotic prescription rates as outcome measure, without looking at the quality of antibiotic use, i.e the rate of over-and underprescription. Quality benchmarks like evidence based prescription rates, variation of use over seasons and number of different types of antibiotics prescribed are not yet employed in quality assurance programs.
The reviews mentioned above did not include studies published during the last three years and papers on pragmatic studies without comparison with controls. In pursuit of research objective three the following activities/sub-objectives are foreseen:

  1. To combine recent evidence and data from non-experimental projects with the existing reviews on behavioural programs aiming at a more evidence-based use of antibiotics by medical professionals in primary care;
  2. To model the cost-effectiveness of interventions aiming at a more evidence-based use of antibiotics in primary care.

 

4. To review current guidelines on antimicrobial therapy of respiratory tract infections in European primary care
To enable the development of tools to improve antibiotic use in European primary care, it is necessary to have an overview of the different guidelines in this field in the different member states. Guidelines reflect the available evidence, but also show how local experts have interpreted this evidence and what management is regarded as feasible for the users of those guidelines. Partners who participate in this proposal are authors of both national and international guidelines. They have noted considerable differences across Europe in the interpretation of available evidence on the effectiveness of antibiotics. Reviewing guidelines in this field and analysis of differences between guidelines therefore is very important in the process of development of European strategies to rationalise antibiotic use.  In pursuit of research objective one the following activities/sub-objectives are foreseen:

  1. To review guidelines from European member states and, when applicable, international European guidelines on antimicrobial therapy of otitis media, sinusitis, acute sore throat and acute bronchitis.
  2. To analyse differences between guidelines mentioned under -1- and between European guidelines and guidelines from North America and Australia on the same topics. 

 

5. To review existing educational programs on antimicrobial therapy in respiratory tract infections for medical students and trainees in general practice
Strategies to implement evidence based use of antibiotics should start by appropriate training of medical students and trainees in vocational training programs. To our knowledge, until now no comprehensive overview of educational programs, used in European medical school and other training programs was made. An analysis of differences and teaching methods that could be used in other countries could be of great value for the development of a European policy to ensure a prudent use of antibiotics by young doctors in the near future. In pursuit of research objective five the following activities/sub-objectives are foreseen:

  1. To gather information from the 11 countries participating in the GRACE project on educational programs from medical schools and vocational programs in primary care on antibiotic therapy in respiratory tract infections
  2. To analyse this information and compare contents and methods used in the different member states

 

6. To develop tools for effective behavioural changes towards a more prudent use of anti-microbial agents
Based on the activities that will be carried out under research objectives 1, to 5, CHAMP aims to develop tools for influencing behaviour aimed at a prudent use of antimicrobials, better uptake of immunisation programs and a more rational illness behaviour. The information that is gathered in the other work packages has to be integrated and priorities have to be made. One of the most important challenges will be to develop generic tools that can be used throughout Europe but that can be adapted according to regional differences in perception of illness and appreciation of health care. In pursuit of research objective six, the following activities/sub-objectives are foreseen:

  1. To compare effectiveness and cost-effectiveness of public campaigns and behavioural programs aiming at the evidence based use of antibiotics.
  2. To study the relation between views and attitudes and patients and doctors towards respiratory tract infections, preventive measurements and antimicrobial therapy on the one hand and the effects of behavioural programs and public campaigns on the other hand.
  3. To reach consensus among experts on tools to improve the behaviour of medical professionals and the public concerning prevention and management of infectious diseases and antibiotic use.
  4. To explore the feasibility of behavioural programs in daily practice in different European settings.
CHAMP