Relationship Between Prescribing of Antibiotics and Other Medicines in Primary Care: a Cross-sectional Study

Overview

Journal Br J Gen Pract

Specialty Public Health

Date 2018 Dec 19

PMID 30559110

Citations 14

Authors

Yan Li

Anna Molter

Andrew White

William Welfare

Victoria Palin

Miguel Belmonte

Darren M Ashcroft

Matthew Sperrin

Tjeerd Pieter van Staa

Affiliations

Soon will be listed here.

Abstract

Background: High levels of antibiotic prescribing are a major concern as they drive antimicrobial resistance. It is currently unknown whether practices that prescribe higher levels of antibiotics also prescribe more medicines in general.

Aim: To evaluate the relationship between antibiotic and general prescribing levels in primary care.

Design And Setting: Cross-sectional study in 2014-2015 of 6517 general practices in England using NHS digital practice prescribing data (NHS-DPPD) for the main study, and of 587 general practices in the UK using the Clinical Practice Research Datalink for a replication study.

Method: Linear regression to assess determinants of antibiotic prescribing.

Results: NHS-DPPD practices prescribed an average of 576.1 antibiotics per 1000 patients per year (329.9 at the 5th percentile and 808.7 at the 95th percentile). The levels of prescribing of antibiotics and other medicines were strongly correlated. Practices with high levels of prescribing of other medicines (a rate of 27 159.8 at the 95th percentile) prescribed 80% more antibiotics than low-prescribing practices (rate of 8815.9 at the 5th percentile). After adjustment, NHS-DPPD practices with high prescribing of other medicines gave 60% more antibiotic prescriptions than low-prescribing practices (corresponding to higher prescribing of 276.3 antibiotics per 1000 patients per year). Prescribing of non-opioid painkillers and benzodiazepines were also strong indicators of the level of antibiotic prescribing. General prescribing levels were a much stronger driver for antibiotic prescribing than other risk factors, such as deprivation.

Conclusion: The propensity of GPs to prescribe medications generally is an important driver for antibiotic prescribing. Interventions that aim to optimise antibiotic prescribing will need to target general prescribing behaviours, in addition to specifically targeting antibiotics.

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References

Steinke D, Bain D, MacDonald T, Davey P . Practice factors that influence antibiotic prescribing in general practice in Tayside. J Antimicrob Chemother. 2000; 46(3):509-12. DOI: 10.1093/jac/46.3.509. View

Sundararajan V, Henderson T, Perry C, Muggivan A, Quan H, Ghali W . New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. J Clin Epidemiol. 2004; 57(12):1288-94. DOI: 10.1016/j.jclinepi.2004.03.012. View

Wang K, Seed P, Schofield P, Ibrahim S, Ashworth M . Which practices are high antibiotic prescribers? A cross-sectional analysis. Br J Gen Pract. 2009; 59(567):e315-20. PMC: 2751935. DOI: 10.3399/bjgp09X472593. View

Costelloe C, Metcalfe C, Lovering A, Mant D, Hay A . Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ. 2010; 340:c2096. DOI: 10.1136/bmj.c2096. View

Charani E, Cooke J, Holmes A . Antibiotic stewardship programmes--what's missing?. J Antimicrob Chemother. 2010; 65(11):2275-7. DOI: 10.1093/jac/dkq357. View

Hacking J, Muller S, Buchan I . Trends in mortality from 1965 to 2008 across the English north-south divide: comparative observational study. BMJ. 2011; 342:d508. PMC: 3039695. DOI: 10.1136/bmj.d508. View

Covvey J, Johnson B, Elliott V, Malcolm W, Mullen A . An association between socioeconomic deprivation and primary care antibiotic prescribing in Scotland. J Antimicrob Chemother. 2013; 69(3):835-41. DOI: 10.1093/jac/dkt439. View

Ohl C, Luther V . Health care provider education as a tool to enhance antibiotic stewardship practices. Infect Dis Clin North Am. 2014; 28(2):177-93. DOI: 10.1016/j.idc.2014.02.001. View

Gulliford M, van Staa T, Dregan A, McDermott L, McCann G, Ashworth M . Electronic health records for intervention research: a cluster randomized trial to reduce antibiotic prescribing in primary care (eCRT study). Ann Fam Med. 2014; 12(4):344-51. PMC: 4096472. DOI: 10.1370/afm.1659. View

10.

Gulliford M, Dregan A, Moore M, Ashworth M, van Staa T, McCann G . Continued high rates of antibiotic prescribing to adults with respiratory tract infection: survey of 568 UK general practices. BMJ Open. 2014; 4(10):e006245. PMC: 4212213. DOI: 10.1136/bmjopen-2014-006245. View

11.

Llor C, Bjerrum L . Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem. Ther Adv Drug Saf. 2014; 5(6):229-41. PMC: 4232501. DOI: 10.1177/2042098614554919. View

12.

Herrett E, Gallagher A, Bhaskaran K, Forbes H, Mathur R, van Staa T . Data Resource Profile: Clinical Practice Research Datalink (CPRD). Int J Epidemiol. 2015; 44(3):827-36. PMC: 4521131. DOI: 10.1093/ije/dyv098. View

13.

Harris A, Hicks L, Qaseem A . Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. 2016; 164(6):425-34. DOI: 10.7326/M15-1840. View

14.

Hallsworth M, Chadborn T, Sallis A, Sanders M, Berry D, Greaves F . Provision of social norm feedback to high prescribers of antibiotics in general practice: a pragmatic national randomised controlled trial. Lancet. 2016; 387(10029):1743-52. PMC: 4842844. DOI: 10.1016/S0140-6736(16)00215-4. View

15.

Norris P, Chamberlain K, Dew K, Gabe J, Hodgetts D, Madden H . Public Beliefs about Antibiotics, Infection and Resistance: A Qualitative Study. Antibiotics (Basel). 2016; 2(4):465-76. PMC: 4790263. DOI: 10.3390/antibiotics2040465. View

16.

Diamond J, McQuillan J, Spiegel A, Hill P, Smith R, West J . Viruses, Vaccines and the Public. Mus Soc Issues. 2016; 11(1):9-16. PMC: 4980086. DOI: 10.1080/15596893.2016.1131099. View

17.

Aabenhus R, Siersma V, Sandholdt H, Koster-Rasmussen R, Hansen M, Bjerrum L . Identifying practice-related factors for high-volume prescribers of antibiotics in Danish general practice. J Antimicrob Chemother. 2017; 72(8):2385-2391. DOI: 10.1093/jac/dkx115. View

18.

Avery A . Pharmacists working in general practice: can they help tackle the current workload crisis?. Br J Gen Pract. 2017; 67(662):390-391. PMC: 5569715. DOI: 10.3399/bjgp17X692201. View

19.

Tonkin-Crine S, Tan P, Van Hecke O, Wang K, Roberts N, McCullough A . Clinician-targeted interventions to influence antibiotic prescribing behaviour for acute respiratory infections in primary care: an overview of systematic reviews. Cochrane Database Syst Rev. 2017; 9:CD012252. PMC: 6483738. DOI: 10.1002/14651858.CD012252.pub2. View

20.

Bush J, Langley C, Jenkins D, Johal J, Huckerby C . Clinical pharmacists in general practice: an initial evaluation of activity in one English primary care organisation. Int J Pharm Pract. 2017; 26(6):501-506. DOI: 10.1111/ijpp.12426. View