Influence of patient payment on antibiotic prescribing in Irish general practice: a cohort study

Murphy, Marie; Byrne, Stephen; Bradley, Colin

doi:10.3399/bjgp11x593820

Cited by 28 publications

(22 citation statements)

References 23 publications

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“…The majority of ROI citizens must pay a fee to visit their GP and this has shown as a possible influence on the GP’s decision to prescribe an antibiotic during the consultation [10]. …”

Section: Introductionmentioning

confidence: 99%

Antibiotic prescribing in primary care, adherence to guidelines and unnecessary prescribing - an Irish perspective

2012

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BackgroundInformation about antibiotic prescribing practice in primary care is not available for Ireland, unlike other European countries. The study aimed to ascertain the types of antibiotics and the corresponding conditions seen in primary care and whether general practitioners (GPs) felt that an antibiotic was necessary at the time of consultation. This information will be vital to inform future initiatives in prudent antibiotic prescribing in primary care.MethodsParticipating GPs gathered data on all antibiotics prescribed by them in 100 consecutive patients’ consultations as well as data on the conditions being treated and whether they felt the antibiotic was necessary.Results171 GPs collected data on 16,899 consultations. An antibiotic was prescribed at 20.16% of these consultations. The majority were prescribed for symptoms or diagnoses associated with the respiratory system; the highest rate of prescribing in these consultations were for patients aged 15–64 years (62.23%). There is a high rate of 2nd and 3rd line agents being used for common ailments such as otitis media and tonsillitis. Amoxicillin, which is recommended as 1st line in most common infections, was twice as likely to be prescribed if the prescription was for deferred used or deemed unnecessary by the GP.ConclusionThe study demonstrates that potentially inappropriate prescribing is occurring in the adult population and the high rate of broad-spectrum antimicrobial agents is a major concern. This study also indicates that amoxicillin may be being used for its placebo effect rather than specifically for treatment of a definite bacterial infection.

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“…The majority of ROI citizens must pay a fee to visit their GP and this has shown as a possible influence on the GP’s decision to prescribe an antibiotic during the consultation [10]. …”

Section: Introductionmentioning

confidence: 99%

Antibiotic prescribing in primary care, adherence to guidelines and unnecessary prescribing - an Irish perspective

2012

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“…In the USA study most disease was seen in the relatively poor, but resistance was higher in the relatively rich. It is likely that access to healthcare as well as the presence of an infection is important in the risk of antimicrobial resistance; a study in Ireland showed patients treated privately were prescribed antibiotics more often than those treated by the public health system [30]. …”

Section: Discussionmentioning

confidence: 99%

Correlations between Income Inequality and Antimicrobial Resistance

Kirby

Herbert

2013

PLoS ONE

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ObjectivesThe aim of this study is to investigate if correlations exist between income inequality and antimicrobial resistance. This study’s hypothesis is that income inequality at the national level is positively correlated with antimicrobial resistance within developed countries.Data collection and analysisIncome inequality data were obtained from the Standardized World Income Inequality Database. Antimicrobial resistance data were obtained from the European antimicrobial Resistance Surveillance Network and outpatient antimicrobial consumption data, measured by Defined daily Doses per 1000 inhabitants per day, from the European Surveillance of antimicrobial Consumption group. Spearman’s correlation coefficient (r) defined strengths of correlations of: > 0.8 as strong, > 0.5 as moderate and > 0.2 as weak. Confidence intervals and p values were defined for all r values. Correlations were calculated for the time period 2003-10, for 15 European countries.ResultsIncome inequality and antimicrobial resistance correlations which were moderate or strong, with 95% confidence intervals > 0, included the following. Enterococcus faecalis resistance to aminopenicillins, vancomycin and high level gentamicin was moderately associated with income inequality (r= ≥0.54 for all three antimicrobials). Escherichia coli resistance to aminoglycosides, aminopenicillins, third generation cephalosporins and fluoroquinolones was moderately-strongly associated with income inequality (r= ≥0.7 for all four antimicrobials). Klebsiella pneumoniae resistance to third generation cephalosporins, aminoglycosides and fluoroquinolones was moderately associated with income inequality (r= ≥0.5 for all three antimicrobials). Staphylococcus aureus methicillin resistance and income inequality were strongly associated (r=0.87).ConclusionAs income inequality increases in European countries so do the rates of antimicrobial resistance for bacteria including E. faecalis, E. coli, K. pneumoniae and S. aureus. Further studies are needed to confirm these findings outside Europe and investigate the processes that could causally link income inequality and antimicrobial resistance.

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“…In a study conducted in Ireland, Murphy et al note that private patients are significantly more likely to receive antibiotics than patients with state-funded access to health care. 6 It is possible, of course, that patients who pay may delay consultation with their GP, resulting in more severe illness and a consequent greater need for active treatment. However, it is also possible that these discrepancies may represent differences in the way in which patient expectations are managed, and strategies to reduce excessive antibiotic prescribing should take such factors into account.…”

Section: Inappropriate Medicinesmentioning

confidence: 99%

Prescribing safety: the case of inappropriate medicines

Payne

2011

Br J Gen Pract

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Influence of patient payment on antibiotic prescribing in Irish general practice: a cohort study

Cited by 28 publications

References 23 publications

Antibiotic prescribing in primary care, adherence to guidelines and unnecessary prescribing - an Irish perspective

Antibiotic prescribing in primary care, adherence to guidelines and unnecessary prescribing - an Irish perspective

Correlations between Income Inequality and Antimicrobial Resistance

Prescribing safety: the case of inappropriate medicines

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