Antibiotic prescribing patterns of general practice registrars for infective conjunctivitis: a cross-sectional analysis

Abstract

INTRODUCTION: Over-prescription of antibiotics for common infective conditions is an important health issue. Infective conjunctivitis represents one of the most common eye-related complaints in general practice. Despite its self-limiting nature, there is evidence of frequent general practitioner (GP) antibiotic prescribing for this condition, which is inconsistent with evidence-based guidelines. AIM: To investigate the prevalence and associations of GP registrars' (trainees') prescription of antibiotics for infective conjunctivitis. METHODS: We performed a cross-sectional analysis of the Registrar Encounters in Clinical Training (ReCEnT) ongoing prospective cohort study, which documents GP registrars' clinical consultations (involving collection of information from 60 consecutive consultations, at three points during registrar training). The outcome of the analyses was antibiotic prescription for a new diagnosis of conjunctivitis. Patient, registrar, practice and consultation variables were included in uni-and multivariable logistic regression analyses to test associations of these prescriptions. RESULTS: In total, 2333 registrars participated in 18 data collection rounds from 2010 to 2018. There were 1580 new cases of infective conjunctivitis (0.31% of all problems). Antibiotics (mainly topical) were prescribed in 1170 (74%) of these cases. Variables associated with antibiotic prescription included patients' Aboriginal or Torres Strait Islander status, registrar organisation of a follow up (both registrar and other GP follow up), and earlier registrar training term (more junior status). DISCUSSION: GP registrars, like established GPs, prescribe antibiotics for conjunctivitis in excess of guideline recommendations, but prescribing rates are lower in later training. These prescribing patterns have educational, social and economic consequences. Further educational strategies may enhance attenuation of registrars' prescribing during training.

Low-value pharmaceutical care among Dutch GPs: a retrospective cohort study

“…For example, Shekhawat et al used a patient-indication lens and included all GPs in their analysis, 25 whereas Cherry et al included only patients who visited GP registrars in their sample, resulting in distinct assessment denominators and outcomes. 55 …”

“…For example, Shekhawat et al used a patient-indication lens and included all GPs in their analysis, while Cherry et al included only patients who visited GP registrars in their sample resulting in distinct assessment denominators and outcomes. [45,46] Our assessment of non-indicated prescribing of benzodiazepines for non-specific LBP shows that Dutch GPs mostly adhere to professional guidelines. Only 3% of patients received an inappropriate prescription, which is lower compared to the findings of recent studies from the US.…”

“…Previous studies from Australia, the US, and the Netherlands reported between 60% and 80% of patients with infectious conjunctivitis received a non-indicated antibiotics prescription, which is higher compared to our assessment outcome. [20,45,46] The differences between the assessments could be explained by differences in the data sources, study designs and populations included. For example, Shekhawat et al used a patient-indication lens and included all GPs in their analysis, while Cherry et al included only patients who visited GP registrars in their sample resulting in distinct assessment denominators and outcomes.…”

Indication-prescription study for the management of conjunctivitis in a Colombian population

“…We observed that ophthalmic antibiotics were prescribed for more than one third of patients, including a large proportion of those with viral and unspecified conjunctivitis and a smaller proportion of patients with allergic conjunctivitis, for which clinical practice guidelines do not recommend the use of antibiotics [8,9,14]. However, the rate of antibiotics prescriptions for acute conjunctivitis is higher in countries such as the USA (58.0-72.7%) [6,15], Australia (74.0%) [16], Holland (80.0%) [17] and Belgium (89.4%) [7] and lower in different Scandinavian countries (4.2-21.1%) [18]. The present analysis found that the majority of prescriptions were issued by general practitioners, which is consistent with the reports of other publications [6,[15][16][17].…”

Evidence-based strategies for better antibiotic prescribing

“…21 An aspect of clinical uncertainty is that produced by the false dichotomy of viral or bacterial aetiology. As above, addressing the syndromic presentation rather than aetiological diagnosis [5][6][7][8][9][10]22 will lessen uncertainty as a driver of antibiotic prescribing in ARIs and infective conjunctivitis.…”