Follow-up of antibiotic prophylaxis: impact on compliance with guidelines and financial outcomes

In order to enhance the quality of antibiotic use, a new financial system was introduced in Belgium in 1997, which links reimbursement of antibiotic costs incurred during prophylaxis in surgery and obstetrics to compliance with evidence-based guidelines. At University Hospitals Leuven (UHL), this reimbursement scheme was supplemented with a follow-up programme in 2001 that informs physicians of their compliance with the guidelines and outlines the financial consequences of their use of prophylactic antibiotics. The aim of this paper is to evaluate the impact of the follow-up programme developed and implemented by a clinical pharmacist at UHL. The analysis drew on data on consumption and costs of antibiotics used in standard prophylaxis that were retrieved from patient invoices. Both financial outcomes and results on consumption patterns of antibiotics point to an increasing compliance with guidelines. An average annual loss of 92 353€ associated with prophylactic antibiotic use prior to the implementation of the follow-up programme evolved into a profit of 27 269€ following its introduction. The share of consumption of prophylactic antibiotics held by cefazolin and metronidazole, the two main antibiotics recommended by the guidelines, increased substantially or remained stable as a result of the follow-up programme, whereas the shares held by other antibiotics generally fell. Moreover, the range of antibiotics consumed during standard prophylaxis narrowed. This follow-up programme thus reduced antibiotic costs, improved profitability and increased physician compliance with guidelines.