Variation of GP antibiotic prescribing tendency for contacts with out-of-hours primary care in Denmark – a cross-sectional register-based study

Abstract

Objective To study variation in antibiotic prescribing rates among general practitioners (GP) in out-of-hours (OOH) primary care and to explore GP characteristics associated with these rates. Design Population-based observational registry study using routine data from the OOH primary care registration system on patient contacts and antibiotic prescriptions combined with national register data. Setting OOH primary care of the Central Denmark Region. Subjects All patient contacts in 2014–2017. Main outcome measures GPs’ tendency to prescribe antibiotics. Excess variation (not attributable to chance). Results We included 794,220 clinic consultations (16.1% with antibiotics prescription), 281,141 home visits (11.6% antibiotics), and 1,583,919 telephone consultations (5.8% antibiotics). The excess variation in the tendency to prescribe antibiotics was 1.56 for clinic consultations, 1.64 for telephone consultations, and 1.58 for home visits. Some GP characteristics were significantly correlated with a higher tendency to prescribe antibiotics, including ‘activity level’ (i.e. number of patients seen in the past hour) for clinic and telephone consultations, ‘familiarity with OOH care’ (i.e. number of OOH shifts in the past 180 days), male sex, and younger age for home visits. Overall, GP characteristics explained little of the antibiotic prescribing variation seen among GPs (Pseudo r 2 : 0.008–0.025). Conclusion Some variation in the GPs’ tendency to prescribe antibiotics was found for OOH primary care contacts. Available GP characteristics, such as GPs’ activity level and familiarity with OOH care, explained only small parts of this variation. Future research should focus on identifying factors that can explain this variation, as this knowledge could be used for designing interventions. KEY POINTS Current awareness: Antibiotic prescribing rates seem to be higher in out-of-hours than in daytime primary care. Most important results: Antibiotic prescribing rates varied significantly among general practitioners after adjustment for contact- and patient-characteristics. This variation remained even after accounting for variation attributable to chance. General practitioners’ activity level and familiarity with out-of-hours care were positively associated with their tendency to prescribe antibiotics.

‘Brave Enough’: A Qualitative Study of Veterinary Decisions to Withhold or Delay Antimicrobial Treatment in Pets

“…Both the time pressure in a busy clinic (b20), especially being ‘slammed’ on Fridays (c1) and Saturdays (b23, c2), and the lack of other clinic staff to assist with investigations (c2), tended to lower a veterinarian’s threshold for prescribing antimicrobials. Studies of human antimicrobial prescribing suggest similar links between prescribing and time pressure [ 45 ] and difficulty accessing further investigations [ 50 ].…”

Drivers of district-level differences in outpatient antibiotic prescribing in Germany: a qualitative study with prescribers

“…Lower health care provider density as contextual factor has been associated with higher prescription rates in previous international studies [ 35 , 36 ]. In the present study, lower prescriber density has only indirectly been associated with higher prescription rates – in the cases where lower density correlates with suboptimal emergency services prescription guidelines [ 16 ].…”

“…Proximity to animal breeding or fattening farms has also been associated with variations in antibiotic prescriptions [ 15 ]. Further regional differences exist in the quality and accessibility of out-of-hours emergency primary care settings, which have both been associated with an increase in antibiotic prescriptions [ 16 ].…”

Antibiotic prescriptions associated with a diagnosis of acute nasopharyngitis by GPs in France: a retrospective study

“…Several studies have highlighted different factors leading to antibiotics over prescriptions in respiratory tract infections such as GPs overestimating symptoms, clinical uncertainty, patients' expectations and physician' eagerness to meet those expectations, patients and physicians ages [6,[23][24][25][26]. Others factors include workload time pressure and out-of-hours care [12,27]. Strategies proven to reduce antibiotics prescribing include educational interventions for primary care providers, mass media educational campaigns aimed at healthcare professionals and the public [12,28].…”