Project title: “Health Alliance for Prudent Prescribing, Yield And Use of Anti-microbial Drugs

                       In the Treatment of Respiratory Tract Infections”



FP6 programme: Scientific Support to Policies (SSP)


Project number: 044154

Project duration: 01 Apr 2007 – 30 Sep 2010

Project coordinator: Research Unit for General Practice, Odense, Denmark

Website: http://www.happyaudit.org/project_summary.aspx

Involvement: As work package leader representing WONCA Europe


Project summary

The aim of the HAPPY AUDIT is to strengthen the surveillance of respiratory tract infections in primary health care in Europe through development of intervention programmes targeting general practitioners (GPs), parents of young children and healthy adults. The team will study the incidence of respiratory tract infections among patients in general practice and carry out research based on audit registration to explore the existing use of diagnostic tools in patients with respiratory tract infections.

Based on results from audit registrations in primary health care, the team will develop locally adapted intervention programmes, including guidelines, courses for GPs, workshops and patient information leaflets for improving the quality of antibiotic prescription.

The overall aim of the intervention programme is to reduce the occurrence of bacterial resistance by reducing prescribing of unnecessary antibiotics for respiratory tract infections and by improving the use of appropriate antibiotics in suspected bacterial infections.

The proposed method for auditing GPs is called Audit Project Odense (APO). APO has been developed and successfully tested among the different groups of GPs in the Nordic countries. In this project APO will be used at European level involving some 400 GPs from 12 regions with different cultural background and different organisation of primary health care.

Research on the effect of preventive measures will be performed by analysing audit registrations carried out before and after the intervention period. Recommendations for health policy at political level will prepared. The results will be widely disseminated in a Working Conference hosted by the World Association of Family Doctors (WONCA) at the end of the project period.

To ensure public awareness of the risk of resistant bacteria, media campaigns targeting both professionals and the public will be developed and the results, including a guideline for implementing the APO method in primary health care in other countries, will be published.


Infections caused by resistant bacteria lead to an increased mortality, prolonged hospital stay and increased costs. History has told us that this problem will not be solved by the provision of more potent antibiotics by the pharmaceutical industry – quite the contrary. An increased consumption of potent antibiotics inevitably leads to an increased number of resistant bacteria. The control of antibiotic resistance should be solved by other initiatives. A cornerstone of efforts to control antibiotic resistance is to improve the quality of antibiotic prescribing in primary health care, as more than 90% of antibiotics are prescribed by General Practitioners (GPs). The majority of prescribing are for patients with RTI.    


The HAPPY AUDIT project aims to change people’s habits towards prudent use of antimicrobial agents (antibiotics). The proposed method is called Audit Project Odense (APO). APO will be implemented among some 400 General Practitioners (GPs) and their patients and the results will be collected and analysed. The APO method has been developed and successfully tested by GPs in the Nordic countries. Pilot studies have shown that interventions to reduce unnecessary antibiotic prescribing can lead to a reduction in the prevalence of resistant strains. In this project, APO will be implemented at European level including 12 regions with different cultural background and different organisation of primary health care.

General practitioners (GPs) are physicians trained in the principles of the family medicine. They are personal doctors, responsible for giving comprehensive and continuing care to all types of patient irrespective of age, sex and illness. This is the European definition of the role of the GPs, produced for P16 WONCA Europe (The European Society of General Practice/Family medicine).

Expected results:

The HAPPY AUDIT results will be available for future media campaigns at local and European level.
The results will be available to the educational sector. This type of distribution in the educational community ensures that the message has a deep impact on the young generation. At the same time the intervention will have a strong visual potential that will make it appealing to people at all levels. The ambition is to create a differentiated teaching material that is suited for the different age groups.

The project will show examples on best practice and how GPs will benefit from intervention activities. They will underline the message that there are barriers to overcome, but that the changing of behaviour towards prudent use of antibiotics will lead to a healthier society. In this way the intervention will create goodwill, understanding and backing for the public.

Potential applications:

The HAPPY AUDIT is using a bottom-up approach in the trial to change behaviour among professionals. Patients may act as professionals if their knowledge about their diseases is relevant and rational. Especially for young people, familiar with the modern electronic communication messages, there will be a tendency to discuss with doctors and nurses about new therapies as well as question old ones.

Therefore, to create a climate of new knowledge based on science, i.e. Evidence Based Medicine (EBM) will make it possible to start reactions on an interactive and interpersonal level. Family physicians, as well as nurses, co-workers, family members, and friends will be the important messengers.

The consortium is strongly rooted in national health authorities and international organisations. The national and international research activities of relevance will be taken into account when planning the media campaigns.

Thursday the 25th.
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