Trends, Variation, and Factors Influencing Antibiotic Prescribing: A Longitudinal Study in Primary Care Using a Multilevel Modelling Approach

Abstract

Antimicrobial resistance has become one of the greatest threats to global health. Over 80% of antibiotics are prescribed in primary care, with many prescriptions considered to be issued inappropriately. The aim of this study was to examine the association between prescribing rates and demographic, practice, geographic, and socioeconomic characteristics using a multilevel modelling approach. Antibiotic prescribing data by 320 GP surgeries in Northern Ireland were obtained from Business Services Organisation for the years 2014–2020. A linear mixed-effects model was used to identify factors influencing antibiotic prescribing rates. Overall, the number of antibacterial prescriptions decreased by 26.2%, from 1,564,707 items in 2014 to 1,155,323 items in 2020. Lower levels of antibiotic prescribing were associated with urban practices (p < 0.001) and practices in less deprived areas (p = 0.005). The overall decrease in antibacterial drug prescriptions over time was larger in less deprived areas (p = 0.03). Higher prescribing rates were linked to GP practices located in areas with a higher percentage of the population aged ≥65 (p < 0.001) and <15 years (p < 0.001). There were also significant regional differences in antibiotic prescribing. We advocate that any future antibiotic prescribing targets should account for local factors.

Prenatal maternal infections and early childhood developmental outcomes: Analysis of linked administrative health data for Greater Glasgow & Clyde, Scotland

“…On the other hand, infection related prescriptions (and paracetamol prescriptions) cover a much larger number of prenatal infections, as PIS data covers all medicines that are prescribed and dispensed in the community (Information Services Division Scotland, 2022a). However, its accuracy in capturing infections may be affected by geographical or temporal variations in GP prescribing practices (see Devine et al ., 2021; Guthrie et al ., 2022; Pouwels et al ., 2018b), and there have been known issues relating to inappropriate prescribing and overprescribing of antibiotics in the UK and elsewhere (e.g. see Pouwels et al ., 2018a; Smieszek et al ., 2018).…”

Psychological and Cultural Factors Influencing Antibiotic Prescription

“…Likewise, antibiotic prescription varies between practices inside a single country, e.g., the U.K. [48], or within even smaller regions [49][50][51]. There are some interesting patterns.…”

“…There are some interesting patterns. For example, recent studies performed in Northern Ireland [51] or England [49,50] have shown that antibiotic prescription rates tend to be higher in rural practices. A possible explanation is that, in smaller communities, the networks are more tied based on interpersonal relationships [52].…”

City’s infectious disease treatment with antimicrobial agents – a longitudinal one year study of antimicrobials in two cities via wastewater-based epidemiology

“…It has also been highlighted that spatial differences in AA prescribing do occur. Higher AA prescribing rates have been associated with a higher proportion of patients over 65 and under 18, larger population sizes, ruralness, and deprivation (Curtis et al, 2019;Devine et al, 2021;Thomson et al, 2020).…”