Age-related decline in antibiotic prescribing for uncomplicated respiratory tract infections in primary care in England following the introduction of a national financial incentive (the Quality Premium) for health commissioners to reduce use of antibiotics in the community: an interrupted time series analysis

Bou-Antoun, Sabine; Costelloe, Céire; Honeyford, Kate; Mazidi, Mahsa; Hayhoe, Benedict; Holmes, Alison; Johnson, Alan P.; Aylin, Paul

doi:10.1093/jac/dky237

Cited by 55 publications

(48 citation statements)

References 24 publications

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“…Antimicrobial resistance (AMR) is a serious public health problem threatening to undermine modern medicine [1]. Prescribing and consumption of antibiotics is a key driver of resistance and there have been a number of antimicrobial stewardship programs (pay-for-performance, educational, audits, and guidelines) implemented in different countries with the intention of reducing inappropriate antimicrobial prescribing [2][3][4][5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

An Assessment of Potential Unintended Consequences Following a National Antimicrobial Stewardship Program in England: An Interrupted Time Series Analysis

Balinskaite¹,

Bou-Antoun

Johnson

et al. 2018

Clinical Infectious Diseases

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Background The “Quality Premium” (QP) introduced in England in 2015 aimed to financially reward local healthcare commissioners for targeted reductions in primary care antibiotic prescribing. We aimed to evaluate possible unintended clinical outcomes related to this QP. Methods Using Clinical Practice Research Datalink and Hospital Episode Statistics datasets, we examined general practitioner (GP) consultations (visits) and emergency hospital admissions related to a series of predefined conditions of unintended consequences of reduced prescribing. Monthly age- and sex-standardized rates were calculated using a direct method of standardization. We used segmented regression analysis of interrupted time series to evaluate the impact of the QP on seasonally adjusted outcome rates. Results We identified 27334 GP consultations and >5 million emergency hospital admissions with predefined conditions. There was no evidence that the QP was associated with changes in GP consultation and hospital admission rates for the selected conditions combined. However, when each condition was considered separately, a significant increase in hospital admission rates was noted for quinsy, and significant decreases were seen for hospital-acquired pneumonia, scarlet fever, pyelonephritis, and complicated urinary tract conditions. A significant decrease in GP consultation rates was estimated for empyema and scarlet fever. No significant changes were observed for other conditions. Conclusions Findings from this study show that overall there was no significant association between the intervention and unintended clinical consequences, with the exception of a few specific conditions, most of which could be explained through other parallel policy changes or should be interpreted with caution due to small numbers.

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Section: Introductionmentioning

confidence: 99%

An Assessment of Potential Unintended Consequences Following a National Antimicrobial Stewardship Program in England: An Interrupted Time Series Analysis

Balinskaite¹,

Bou-Antoun

Johnson

et al. 2018

Clinical Infectious Diseases

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“…China is not alone. Such a "not in my backyard" attitude is prevalent worldwide [14] and can even lead to increased antibiotic prescriptions [37,65].…”

Section: Attitudesmentioning

confidence: 99%

Knowledge, attitudes and intentions to prescribe antibiotics: a structural equation modeling study of primary care institutions in Hubei, China

Liu

Wang

et al. 2019

Preprint

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Background Antibiotic resistance is one of the most serious global issues, in which physician's rational prescribing plays critical role. However, the determinants of physician's antibiotic use are still inconclusive, particularly in low- and middle income countries (LMICs). This study aimed to measure physician's knowledge and five important sub-attitudes toward antibiotic prescriptions and their impacts on prescribing. Methods A questionnaire survey was conducted on 625 physicians from 67 primary care facilities in Hubei of China. Structural equation modelling (SEM) was applied to test the theoretical framework derived from the theory of Knowledge, Attitudes and Practices (KAP). The attitudes (5 subscales) and behavioral intentions (3 subscales) were measured using a five-point Likert scale ranging from -2 to +2, with a negative score indicating disapproval and a positive score indicating approval of efforts for reducing antibiotic prescriptions. Results The study participants had a low level of knowledge about antibiotic prescriptions, giving an average of 54.55% correct answers to 11 questions. Although they were generally concerned about antibiotic resistance resulting from over-prescriptions (Mean of Ignorance=1.28, SD=0.43), and were reluctant to be submissive to pressures from consumer demands for antibiotics (Mean of Complacency=1.29, SD=0.65) and the requirements of defensive practice (Mean of Fear=1.11, SD=0.63), there was a lack of motivation to change prescribing practices (Mean of Indifference=-0.29, SD=0.70). In addition, there was strong agreement that other stakeholders should take the responsibility (Mean of Responsibility Avoidance=-1.15, SD=0.45). The SEM results showed that poor knowledge was a significant predictor (p<0.001) of high intentions to prescribe antibiotics for upper respiratory tract infections and a less positive attitude toward concerns about antibiotic resistance (ignorance) which was also associated with intentions to prescribe antibiotics. However, knowledge was not connected with the negative attitude toward motivation (indifference), a significant predictor (p<0.001) of intentions to refuse to reduce antibiotic prescriptions. Conclusion Physicians in primary care facilities in Hubei have low levels of knowledge about antibiotic prescriptions. But actions for improving knowledge by itself is not enough to curb over-prescriptions of antibiotics. The lack of motivation of physicians to change prescribing practices needs to be addressed through a systems approach.

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“…Наиболее частыми возбудителями острых респираторных инфекций (ОРИ) являются вирусы (80-95 %): аденовирусы, респираторно-синцитиальный вирус, вирусы гриппа и парагриппа, риновирусы, коронавирусы, вирусы ЕСНО и коксаки (тип А и В). Поскольку респираторные вирусные инфекции являются самоэлиминирующимися заболеваниями [1,11], мы считаем обоснованным использование именно симптоматической терапии во всех случаях первичного обращения за медицинской помощью при неосложненном течении ОРИ. Комплексное симптоматическое лечение ОРИ с использованием фитопрепаратов позволяет сократить длительность заболевания, снизить риск развития осложнений и улучшить качество жизни пациентов во время заболевания.…”

Section: Introductionunclassified

Новые Терапевтические Возможности Фитопрепаратов При Лечении Острых Респираторных Инфекций У Детей

Агафонова¹,

Никулина²,

Петренко³

et al. 2021

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1 ГУ «Днепропетровская медицинская академия МЗ Украины», г. Днепр, Украина 2 КУ «Днепровская городская детская клиническая больница № 5», г. Днепр, Украина Новые терапевтические возможности фитопрепаратов при лечении острых респираторных инфекций у детей Резюме. Поскольку респираторные вирусные инфекции являются самоэлиминирующимися заболеваниями, во всех случаях неосложненного течения острых респираторных инфекций мы считаем наиболее обоснованной симптоматическую терапию. Важной частью этой терапии у детей являются фитопрепараты, при условии применения только тех растительных лекарственных средств, которые обладают высоким профилем эффективности и безопасности. В статье представлены новые данные о поливалентных (противовирусных, противомикробных, иммуностимулирующих и противокашлевых) свойствах растительных препаратов ЭВКАБАЛ ® (Esparma GmbH, Германия) -Эвкабал СИРОП и Эвкабал БАЛЬЗАМ, предназначенных для лечения острых респираторных инфекций у детей. Ключевые слова: фитопрепараты; острые респираторные инфекции; кашель; дети; симптоматическая терапия

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Abstract: Community prescribing of antibiotics for RTIs significantly decreased following the introduction of the Quality Premium, with the greatest reduction seen in younger patients.

Cited by 55 publications

References 24 publications

An Assessment of Potential Unintended Consequences Following a National Antimicrobial Stewardship Program in England: An Interrupted Time Series Analysis

An Assessment of Potential Unintended Consequences Following a National Antimicrobial Stewardship Program in England: An Interrupted Time Series Analysis

Knowledge, attitudes and intentions to prescribe antibiotics: a structural equation modeling study of primary care institutions in Hubei, China

Новые Терапевтические Возможности Фитопрепаратов При Лечении Острых Респираторных Инфекций У Детей

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