Exploring the appropriateness of antibiotic prescribing for common respiratory tract infections in UK primary care
Exploring the appropriateness of antibiotic prescribing for common respiratory tract infections in UK primary care
Objectives: To use illness severity scores to evaluate the appropriateness of antibiotic prescribing in UK general practice. Methods: We describe variations in practice prescribing rates, taking account of illness severity. We used three scores in three studies to measure severity: 'FeverPAIN' in an adult acute sore throat cohort (n=12 829), the '3C score' in an adult acute lower respiratory tract infection cohort (n=28 883) and the STARWAVe score in an acute cough and respiratory infection children's cohort (n=8394). We calculated median ORs to quantify practice-level variation in prescribing rates, adjusted for illness severity. Results: There was substantial variability in practice prescribing rates (ranges of 0%-97%, 7%-100% and 0%-75% in the three cohorts, respectively). There was evidence that higher prescribing practices saw a higher proportion of unwell patients. At the individual level, patients who were more unwell were more likely to receive a prescription, but prescribing levels for those with low scores were still high. The median OR was 2.5 (95% credible interval=2.2-2.9) in the sore throat data set, 2.9 (95% credible interval=2.6-3.2) in the adult cough data set and 2.1 (95% credible interval=1.8-2.4) in the children's cough data set. Conclusions: Higher prescribing practices may see more unwell patients with high illness severity scores, but the differences in scores account for a minority of between-practice prescribing variation. There is likely to be scope for further reductions in antibiotic prescribing among patients with low illness severity scores. Further research is needed to explore the additional factors that account for variation in prescribing levels.
236-242
Stuart, Beth
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Brotherwood, Hannah
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Van't Hoff, Catherine
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Brown, Alastair
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Bruel, Ann Van den
17075d83-ab49-4c49-a5f7-14cdff9301f4
Hay, Alastair
e493ad13-cd46-4587-88f8-45f789fdb878
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
1 January 2020
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
Brotherwood, Hannah
d70097c4-f252-404b-8206-15e1bd754a62
Van't Hoff, Catherine
6b3af0b9-67b0-4398-9273-4533344acda7
Brown, Alastair
07d1201c-855a-4e56-b5c7-65201b9ee463
Bruel, Ann Van den
17075d83-ab49-4c49-a5f7-14cdff9301f4
Hay, Alastair
e493ad13-cd46-4587-88f8-45f789fdb878
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Stuart, Beth, Brotherwood, Hannah, Van't Hoff, Catherine, Brown, Alastair, Bruel, Ann Van den, Hay, Alastair, Moore, Michael and Little, Paul
(2020)
Exploring the appropriateness of antibiotic prescribing for common respiratory tract infections in UK primary care.
Journal of Antimicrobial Chemotherapy, 75 (1), .
(doi:10.1093/jac/dkz410).
Abstract
Objectives: To use illness severity scores to evaluate the appropriateness of antibiotic prescribing in UK general practice. Methods: We describe variations in practice prescribing rates, taking account of illness severity. We used three scores in three studies to measure severity: 'FeverPAIN' in an adult acute sore throat cohort (n=12 829), the '3C score' in an adult acute lower respiratory tract infection cohort (n=28 883) and the STARWAVe score in an acute cough and respiratory infection children's cohort (n=8394). We calculated median ORs to quantify practice-level variation in prescribing rates, adjusted for illness severity. Results: There was substantial variability in practice prescribing rates (ranges of 0%-97%, 7%-100% and 0%-75% in the three cohorts, respectively). There was evidence that higher prescribing practices saw a higher proportion of unwell patients. At the individual level, patients who were more unwell were more likely to receive a prescription, but prescribing levels for those with low scores were still high. The median OR was 2.5 (95% credible interval=2.2-2.9) in the sore throat data set, 2.9 (95% credible interval=2.6-3.2) in the adult cough data set and 2.1 (95% credible interval=1.8-2.4) in the children's cough data set. Conclusions: Higher prescribing practices may see more unwell patients with high illness severity scores, but the differences in scores account for a minority of between-practice prescribing variation. There is likely to be scope for further reductions in antibiotic prescribing among patients with low illness severity scores. Further research is needed to explore the additional factors that account for variation in prescribing levels.
Text
Exploring the appropriateness of variation accepted copy
- Accepted Manuscript
More information
Accepted/In Press date: 29 August 2019
e-pub ahead of print date: 21 October 2019
Published date: 1 January 2020
Additional Information:
Funding Information:
This study was carried out as part of our routine work and represents a secondary analysis of existing data. However, the original collection and analyses of the data was funded as follows: the DESCARTE cohort was funded by the UK Medical Research Council; the 3C cohort was funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (reference no. RP-PG-0407-10098); and the TARGET cohort was funded by the NIHR under its Programme Grants for Applied Research Programme (reference no. RP-PG-0608-10018). A.D.H. holds an NIHR Senior Investigator Award (NIHR200151).
Publisher Copyright:
© 2019 The Author(s). Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.
Identifiers
Local EPrints ID: 434587
URI: http://eprints.soton.ac.uk/id/eprint/434587
ISSN: 0305-7453
PURE UUID: bdc9e619-2990-4458-84bf-c7e8937f0ec1
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Date deposited: 02 Oct 2019 16:30
Last modified: 12 Jul 2024 04:04
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Contributors
Author:
Hannah Brotherwood
Author:
Catherine Van't Hoff
Author:
Alastair Brown
Author:
Ann Van den Bruel
Author:
Alastair Hay
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