Antibiotic prescribing patterns in general medical practices in England: Does area matter?

Mölter, Anna; Belmonte, Miguel; Palin, Victoria; Mistry, Chirag; Sperrin, Matthew; White, Andrew; Welfare, William; Staa, Tjeerd van

doi:10.1016/j.healthplace.2018.07.004

Cited by 30 publications

(35 citation statements)

References 31 publications

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“…Another study by Mölter and colleagues, who analysed antibiotic prescribing by GP practice in England, identi ed spatial clusters of high and low spots of prescribing (so-called 'hot' and 'cold' spots). 27 The work showed that the distribution of antibiotic prescribing was heterogeneous, with the majority of the hot spots located in the North of England. Our results con rm this as we found that, when controlling for demographic, and health need variables, highest levels of prescribing were found in the North East, and East of England; lowest levels of antibiotic prescribing were consistently found in London.…”

Section: Discussionmentioning

confidence: 99%

An examination of trends in antibiotic prescribing in primary care and the association with area-level deprivation in England

Thomson

Berry

Robinson

et al. 2020

Preprint

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Background Internationally, there are growing concerns about antimicrobial resistance. This has resulted in increased scrutiny of antibiotic prescribing trends – particularly in primary care where the majority of prescribing occurs. In England, antibiotic prescribing targets are set nationally but little is known about the local context of antibiotic prescribing. This study aimed to examine trends in antibiotic prescribing (including broad-spectrum), and the association with area-level deprivation and region in England. Methods Antibiotic prescribing data by GP surgery in England were obtained from NHS Business Service Authority for the years 2014-2018. These data were matched with the Index of Multiple Deprivation (IMD 2015) at the Lower Layer Super Output level (LSOA). Linear regression methods were employed to explore the relationship between antibiotic use and area-level deprivation as well as region, after controlling for a range of other confounding variables, including health need, rurality, and ethnicity. Results Over time, the amount of antibiotic prescribing significantly reduced from 1.11 items per STAR-PU to 0.96 items per STAR-PU – a reduction of 13.6%. The adjusted models found that, at LSOA level, the most deprived areas of England had the highest levels of antibiotic prescribing (0.03 items per STAR-PU higher). However, broad spectrum antibiotic prescribing exceeding 10% of all antibiotic prescribing within a GP practice was higher in more affluent areas. There were also significant regional differences – with the North East and the East of England having the highest levels of antibiotic prescribing (by 0.16 items per STAR-PU).Conclusion Although antibiotic prescribing has reduced over time, there remains significant variation in by area-level deprivation and region in England – with higher antibiotic prescribing in more deprived areas. Future prescribing targets should account for local factors to ensure the most deprived communities are not inappropriately penalised.

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Section: Discussionmentioning

confidence: 99%

An examination of trends in antibiotic prescribing in primary care and the association with area-level deprivation in England

Thomson

Berry

Robinson

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Another study by Mölter and colleagues, who analysed antibiotic prescribing by GP practice in England, identified spatial clusters of high and low spots of prescribing (so-called 'hot' and 'cold' spots). 17 The work showed that the distribution of antibiotic prescribing was heterogeneous, with the majority of the hot spots located in the North of England. Importantly, the work concluded that, in addition to a national level strategic approach, local antimicrobial stewardship approaches may also be needed at an area level to account for specific pressures and needs.…”

Section: Discussionmentioning

confidence: 99%

An examination of trends in antibiotic prescribing by area-level deprivation in England

Thomson¹,

Berry²,

Robinson³

et al. 2020

Preprint

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Background As part of an approach to reduce antimicrobial resistance, there has been strategic focus placed on reducing antibiotic prescribing. Given these policy drivers, there is a pressing need to understand the nature of antibiotic prescribing by primary care, and to understand how this changes by socioeconomic deprivation, when controlling for confounding variables. This is crucial in order to inform future antibiotic prescribing targets to ensure such targets do not impact on people with the most health need and thus potentially widen health inequalities.Methods Antibiotic prescribing data for the years 2014-2018 were matched with the Index of Multiple Deprivation (IMD 2015) deciles and graphically presented to explore trends over time. Multi-level analysis on antibiotic use was used to assess the impact of deprivation alongside a range of other confounding variables, including health need, geographic region and GP quality rating.Results Our study highlighted three key results: (1) GP surgeries located in the most deprived areas had the highest levels of antibiotic prescribing (adjusting for health need accounted for most of this variation); (2) there was inequalities in the prescribing of broad spectrum antibiotics according to deprivation; (3) there was significant geographical variation in antibiotic prescribing.Conclusion Future antibiotic prescribing targets should account for deprivation and/or health need to ensure GP practices located in the most deprived communities are not inappropriately penalised.

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“…Extensive studies have been undertaken to explore variations in antibiotic prescribing practices [42][43][44][45][46][47].…”

Section: Strength and Limitationsmentioning

confidence: 99%

“…Despite a shortage of studies comparing individual prescribers, many existing studies point to the great variations in antibiotic prescribing across facilities and regions [8,12,[42][43][44][45][46][47]. The European Surveillance of Antimicrobial Consumption (ESAC) project found that physicians in France used 3.20 times of antibiotics compared with those in the Netherlands [42].…”

Section: Antibiotic Prescribing Patterns Of Primary Care Physiciansmentioning

confidence: 99%

Identifying antibiotic prescribing patterns through multi-level latent profile analyses: a cross-sectional survey of primary care physicians in Hubei of China

Wang¹,

Liu²,

Zhang³

et al. 2020

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Background Overuse of antibiotics significantly fuels the development of AMR, which threating the global population health. Great variations existed in antibiotic prescribing practices among physicians, indicating improvement potential for rational use of antibiotics. This study aims to identify antibiotic prescribing patterns of primary care physicians and potential determinants. Methods A cross-sectional survey was conducted on 551 physicians from 67 primary care facilities in Hubei selected through random cluster sampling, tapping into their knowledge, attitudes and prescribing practices toward antibiotics. Prescriptions (n=501,072) made by the participants from 1 January to 31 March 2018 were extracted from the medical records system. Seven indicators were calculated for each prescriber: average number of medicines per prescription, average number of antibiotics per prescription, percentage of prescriptions containing antibiotics, percentage of antibiotic prescriptions containing broad-spectrum antibiotics, percentage of antibiotic prescriptions containing parenteral administered antibiotics, percentage of antibiotic prescriptions containing restricted antibiotics, and percentage of antibiotic prescriptions containing antibiotics included in the WHO “Watch and Reserve” list. Two-level latent profile analyses were performed to identify the antibiotic prescribing patterns of physicians based on those indicators. Multi-nominal logistic regression models were established to identify determinants with the antibiotic prescribing patterns. Results On average, each primary care physician issued 909 (ranging from 100 to 11941 with a median of 474) prescriptions over the study period. The mean percentage of prescriptions containing antibiotics issued by the physicians reached 52.19% (SD=17.20%). Of those antibiotic prescriptions, an average of 82.29% (SD=15.83%) contained broad-spectrum antibiotics; 71.92% (SD=21.42%) contained parenteral administered antibiotics; 23.52% (SD=19.12%) contained antibiotics restricted by the regional government; and 67.74% (SD=20.98%) contained antibiotics listed in the WHO “Watch and Reserve” list. About 28.49% of the prescribers were identified as low antibiotic users, compared with 51.18% medium users and 20.33% high users. Higher use of antibiotics was associated with insufficient knowledge, indifference to changes, complacency with satisfied patients, low household income and rural location of the prescribers. Conclusion Great variation in antibiotic prescribing patterns exists among primary care physicians in Hubei of China. High use of antibiotics is not only associated with knowledge shortfalls but also low socioeconomic status of prescribers.

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Antibiotic prescribing patterns in general medical practices in England: Does area matter?

Cited by 30 publications

References 31 publications

An examination of trends in antibiotic prescribing in primary care and the association with area-level deprivation in England

An examination of trends in antibiotic prescribing in primary care and the association with area-level deprivation in England

An examination of trends in antibiotic prescribing by area-level deprivation in England

Identifying antibiotic prescribing patterns through multi-level latent profile analyses: a cross-sectional survey of primary care physicians in Hubei of China

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