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Potential for reducing inappropriate antibiotic prescribing in English primary care

Potential for reducing inappropriate antibiotic prescribing in English primary care
Potential for reducing inappropriate antibiotic prescribing in English primary care

Objectives: To identify and quantify inappropriate systemic antibiotic prescribing in primary care in England, and ultimately to determine the potential for reduction in prescribing of antibiotics. Methods: Primary care data from 2013-15 recorded in The Health Improvement Network (THIN) database were used. Potentially inappropriate prescribing events in the database were identified by: (i) comparing prescribing events against treatment guidelines; (ii) comparing actual proportions of consultations resulting in prescription for a set of conditions with the ideal proportions derived from expert opinion; and (iii) identifying high prescribers and their number of prescriptions above an age- and body-system-specific benchmark. Results: Applying the most conservative assumptions, 8.8% of all systemic antibiotic prescriptions in English primary care were identified as inappropriate, and in the least conservative scenario 23.1% of prescriptions were inappropriate. All practices had non-zero reduction potentials, ranging from 6.4% to 43.5% in the middle scenario. The four conditions that contributed most to inappropriate prescribing were sore throat (23.0% of identified inappropriate prescriptions), cough (22.2%), sinusitis (7.6%) and acute otitis media (5.7%). One-third of all antibiotic prescriptions lacked an informative diagnostic code. Conclusions: This work demonstrates (i) the existence of substantial inappropriate antibiotic prescribing and (ii) poor diagnostic coding in English primary care. All practices (not just the high prescribers) should engage in efforts to improve antimicrobial stewardship. Better diagnostic coding, more precise prescribing guidelines and a deeper understanding of appropriate long-term uses of antibioticswould allowidentification of further potential for reductions.

0305-7453
ii36-ii43
Smieszek, Timo
1f3ee3f3-5ffa-4f45-baf4-139ebad098dc
Pouwels, Koen B.
0f98f313-4c0b-42d9-9a50-183d32005db3
Dolk, F. Christiaan K.
98dbf8f6-449d-41c5-91eb-c1cbad7def3a
Smith, David R.M.
217b19f1-7588-4d54-a062-8394eea6dea1
Hopkins, Susan
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Sharland, Mike
96d06604-3981-4f7f-97a7-27894b16308c
Hay, Alastair D.
bfae9e44-ae9b-473c-923f-1dea50747023
Moore, Michael V.
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Robotham, Julie V.
5eac446d-30cd-43dd-a363-5e8f240093ce
Smieszek, Timo
1f3ee3f3-5ffa-4f45-baf4-139ebad098dc
Pouwels, Koen B.
0f98f313-4c0b-42d9-9a50-183d32005db3
Dolk, F. Christiaan K.
98dbf8f6-449d-41c5-91eb-c1cbad7def3a
Smith, David R.M.
217b19f1-7588-4d54-a062-8394eea6dea1
Hopkins, Susan
a9f3ef09-c1f1-4020-9423-1c739833f8fb
Sharland, Mike
96d06604-3981-4f7f-97a7-27894b16308c
Hay, Alastair D.
bfae9e44-ae9b-473c-923f-1dea50747023
Moore, Michael V.
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Robotham, Julie V.
5eac446d-30cd-43dd-a363-5e8f240093ce

Smieszek, Timo, Pouwels, Koen B., Dolk, F. Christiaan K., Smith, David R.M., Hopkins, Susan, Sharland, Mike, Hay, Alastair D., Moore, Michael V. and Robotham, Julie V. (2018) Potential for reducing inappropriate antibiotic prescribing in English primary care. Journal of Antimicrobial Chemotherapy, 73 (2), ii36-ii43. (doi:10.1093/jac/dkx500).

Record type: Article

Abstract

Objectives: To identify and quantify inappropriate systemic antibiotic prescribing in primary care in England, and ultimately to determine the potential for reduction in prescribing of antibiotics. Methods: Primary care data from 2013-15 recorded in The Health Improvement Network (THIN) database were used. Potentially inappropriate prescribing events in the database were identified by: (i) comparing prescribing events against treatment guidelines; (ii) comparing actual proportions of consultations resulting in prescription for a set of conditions with the ideal proportions derived from expert opinion; and (iii) identifying high prescribers and their number of prescriptions above an age- and body-system-specific benchmark. Results: Applying the most conservative assumptions, 8.8% of all systemic antibiotic prescriptions in English primary care were identified as inappropriate, and in the least conservative scenario 23.1% of prescriptions were inappropriate. All practices had non-zero reduction potentials, ranging from 6.4% to 43.5% in the middle scenario. The four conditions that contributed most to inappropriate prescribing were sore throat (23.0% of identified inappropriate prescriptions), cough (22.2%), sinusitis (7.6%) and acute otitis media (5.7%). One-third of all antibiotic prescriptions lacked an informative diagnostic code. Conclusions: This work demonstrates (i) the existence of substantial inappropriate antibiotic prescribing and (ii) poor diagnostic coding in English primary care. All practices (not just the high prescribers) should engage in efforts to improve antimicrobial stewardship. Better diagnostic coding, more precise prescribing guidelines and a deeper understanding of appropriate long-term uses of antibioticswould allowidentification of further potential for reductions.

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Accepted/In Press date: 1 February 2018
e-pub ahead of print date: 27 February 2018
Published date: February 2018
Additional Information: Crown copyright information is reproduced with the permission of the Controller of HMSO and the Queen’s Printer for Scotland.

Identifiers

Local EPrints ID: 419069
URI: http://eprints.soton.ac.uk/id/eprint/419069
ISSN: 0305-7453
PURE UUID: 38ea96ed-2924-4901-b34b-642a7802b027
ORCID for Michael V. Moore: ORCID iD orcid.org/0000-0002-5127-4509

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Date deposited: 28 Mar 2018 16:30
Last modified: 17 Dec 2019 01:46

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Contributors

Author: Timo Smieszek
Author: Koen B. Pouwels
Author: F. Christiaan K. Dolk
Author: David R.M. Smith
Author: Susan Hopkins
Author: Mike Sharland
Author: Alastair D. Hay
Author: Julie V. Robotham

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