The ENORM study

ENORM (Educational intervention in NORwegian Municipalities for antibiotic treatment in line with guidelines) is the English name of the scientific part of the RAK (Riktigere Antibiotikabruk i Kommunene) project.

Antimicrobial resistance is a growing threat to public health. Any use of antibiotics increases the risk of adverse clinical effects of antimicrobial resistance. Antibiotics should be used only when there is reason to believe that they will provide an important and positive effect.

About 80% of all antibiotics in Norway are prescribed in general practice, and studies have shown that a significant proportion of this is used in cases where antibiotics are not expected to give any important effect. Quality improvement programmes facing GPs result in a lower and more appropriate prescribing of antibiotics, but such programmes are expensive, and so far they have not been implemented nationally.

In the project ENORM – Educational intervention in Norwegian Municipalities for antibiotic treatment in line with guidelines, we want to develop and test a quality improvement programme that easily can be offered to all GPs in Norway. The idea is to create the programme so simple and inexpensive that it becomes attractive both for doctors and health authorities. To achieve this, we will use individuals and entities that already have a role and a responsibility in the fight against antimicrobial resistance; municipal doctors, NorPD (The Norwegian Prescription Database), and SKIL (The Norwegian Quality Centre for Outpatient Clinics). The preparation of the quality improvement programme will be guided by qualitative studies among municipal doctors and general practitioners.

By September 2018, the quality improvement project has been fully developed, following the input of municipal doctors and general practitioners. The project consists of a 15-hour clinical course, divided into three e-learning courses and three group meetings. Two personal antibiotic prescribing reports are prepared – one before the start of the course, and another after six months, to allow participants to see if they have changed their prescribing practices. Discussion about these reports is the main content of the group meetings. The group meetings are spread over time so that the entire course is conducted in about eight months. 30 randomly selected municipalities have been invited to participate in a comparative study to explore the impact of the course. Almost all municipal doctors from the invited municipalities attended the start-up meeting at in February 2017. Then the municipal doctors have invited the local general practitioners to attend the course. Approximately 70% of all general practitioners in the invited municipalities have signed up for the course. All these GPs are now finished with the course, and we are investigating whether the antibiotics use in the 30 participating municipalities differs from the antibiotics use in 30 randomly selected control municipalities.