Quality indicators for diagnosis and treatment of respiratory tract infections in general practice: The HAPPY AUDIT project

Objective: To develop a set of quality indicators focusing on the diagnosis and treatment of respiratory tract infections in general practice. 

Material and methods: A modified 2-round Delphi study was conducted from April to July 2008. A panel of 27 experts (13 countries) comprising mainly general practitioners, clinical microbiologists and clinical pharmacologists was invited. A list of 59 quality indicators focusing on the quality of the diagnostic process, the antibiotic treatment and the choice of antibiotics was generated. A thorough literature review was carried out to ensure that all potential indicators were considered. The experts were asked to rate the relevance of 59 quality indicators with regard to reducing antimicrobial resistance and improving patient health. Consensus for a quality indicator was reached if ≥ 75 % of experts scored the item ≥ 5 on a 7-point Likert scale, ranging from 1 (completely disagree) through 4 (=uncertain) to 7 (completely agree).

Results: A 96% response rate was achieved in both Delphi rounds. A total of 41 of the proposed 59 indicators attained consensus. None of the indicators focusing on the diagnostic process achieved consensus. Consensus was attained for 14 indicators focusing on the decision about antibiotic treatment and for 27 indicators focusing on the choice of antibiotics.

Conclusion: This study resulted in a final set of 41 quality indicators concerning respiratory tract infections in general practice. These indicators may be used to strengthen general practitioners' focus on their management of patients with respiratory tract infections and to identify where it is possible to make improvements.