Health alliance for prudent prescribing and yield of antibiotics in a patient-centred perspective (HAPPY PATIENT): a before-and-after intervention and implementation study protocol
Authors: Bjerrum Anders , García-Sangenís Ana , Modena Daniela , Córdoba Gloria , Bjerrum Lars , Chalkidou Athina , Lykkegaard Jesper , Hansen Malene Plejdrup , Søndergaard Jens , Nexøe Jørgen , Rebnord Ingrid , Sebjørnsen Isabel , Jensen Jette Nygaard , Hansen Matilde Bøgelund , Taxis Katja , Lambert Maarten , Benko Ria , González López-Valcárcel Beatriz , Raynal Fabiana , Barragán Nieves , Touboul Pia , Bruno Pascale , Radzeviciene Ruta , Jaruseviciene Lina , Bandzaite Auste , Godycki-Cwirko Maciek , Kowalczyk Anna , Lionis Christos , Karkana Maria-Nefeli , Anastasaki Marilena , Coleman Jamie , Glasová Helena , van Agtmael Michiel , Tattevin Pierre , Borràs Alicia , Llor Carl 
Published: May 2022

Abstract
Background
Excessive and inappropriate use of antibiotics is the most important driver of antimicrobial resistance. The aim of the HAPPY PATIENT project is to evaluate the adaptation of European Union (EU) recommendations on the prudent use of antimicrobials in human health by evaluating the impact of a multifaceted intervention targeting different categories of healthcare professionals (HCPs) on common community-acquired infectious diseases, especially respiratory and urinary tract infections.

Methods/design
HAPPY PATIENT was initiated in January 2021 and is planned to end in December 2023. The partners of this project include 15 organizations from 9 countries. Diverse HCPs (doctors, nurses, pharmacists, and pharmacy technicians) will be audited by the Audit Project Odense (APO) method before and after an intervention in four different settings: general practice, out of hours services, nursing homes and community pharmacies in four high antibiotic prescribing countries (France, Poland, Greece, and Spain) and one low prescribing country (Lithuania). About 25 individuals from each professional group will be recruited in each country, who will register at least 25 patients with community-acquired infections during each audit period. Shortly before the second registration participants will undertake a multifaceted intervention and will receive the results from the first registration to allow the identification of possible quality problems. At these meetings participants will receive training courses on enhancement of communication skills, dissemination of clinical guidelines with recommendations for diagnosis and treatment, posters for the waiting rooms, and leaflets for patients. The results of the second registration will be compared with those obtained in the first audit.

Discussion
HAPPY PATIENT is an EU-funded project aimed at contributing to the battle against antibiotic resistance through improvement of the quality of management of common community-acquired infections based on interventions by different types of HCPs. It is hypothesized that the use of multifaceted strategies combining active intervention will be effective in reducing inappropriate prescribing and dispensing of antibiotics.

Study registration
EU Health programmes project database https://webgate.ec.europa.eu/chafea_pdb/health/projects/900024/summary; date of registration: 1 January 2021.