Antibiotic prescribing for common infections in UK general practice: variability and drivers.
OBJECTIVES: To examine variations across general practices and factors associated with antibiotic prescribing for common infections in UK primary care to identify potential targets for improvement and optimization of prescribing.
METHODS: Oral antibiotic prescribing for common infections was analysed using anonymized UK primary care electronic health records between 2000 and 2015 using the Clinical Practice Research Datalink (CPRD). The rate of prescribing for each condition was observed over time and mean change points were compared with national guideline updates. Any correlation between the rate of prescribing for each infectious condition was estimated within a practice. Predictors of prescribing were estimated using logistic regression in a matched patient cohort (1:1 by age, sex and calendar time).
RESULTS: Over 8 million patient records were examined in 587 UK general practices. Practices varied considerably in their propensity to prescribe antibiotics and this variance increased over time. Change points in prescribing did not reflect updates to national guidelines. Prescribing levels within practices were not consistent for different infectious conditions. A history of antibiotic use significantly increased the risk of receiving a subsequent antibiotic (by 22%-48% for patients with three or more antibiotic prescriptions in the past 12 months), as did higher BMI, history of smoking and flu vaccinations. Other drivers for receiving an antibiotic varied considerably for each condition.
CONCLUSIONS: Large variability in antibiotic prescribing between practices and within practices was observed. Prescribing guidelines alone do not positively influence a change in prescribing, suggesting more targeted interventions are required to optimize antibiotic prescribing in the UK.
|ジャーナル名||The Journal of antimicrobial chemotherapy|
|投稿者||Palin, Victoria; Molter, Anna; Belmonte, Miguel; Ashcroft, Darren M; White, Andrew; Welfare, William; van Staa, Tjeerd|
|組織名||Greater Manchester Connected Health Cities, School of Health Sciences, Faculty of;Biology, Medicine and Health, The University of Manchester, Oxford Road,;Manchester M13 9PL, UK.;NIHR Greater Manchester Patient Safety Translational Research Centre, School of;Health Sciences, Faculty of Biology, Medicine and Health, The University of;Manchester, Oxford Road, Manchester M13 9PL, UK.;NHS Greater Manchester Shared Service, Ellen House, Waddington Street, Oldham OL9;6EE, UK.;Public Health England North West, 3 Piccadilly Place, London Road, Manchester M1;3BN, UK.;Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of;Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands.|