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Investigating the mechanism of impact and differential effect of the Quality Premium scheme on antibiotic prescribing in England: a longitudinal study

Investigating the mechanism of impact and differential effect of the Quality Premium scheme on antibiotic prescribing in England: a longitudinal study
Investigating the mechanism of impact and differential effect of the Quality Premium scheme on antibiotic prescribing in England: a longitudinal study

Background: In 2017, approximately 73% of antibiotics in England were prescribed from primary care practices. It has been estimated that 9%-23% of antibiotic prescriptions between 2013 and 2015 were inappropriate. Reducing antibiotic prescribing in primary care was included as one of the national priorities in a financial incentive scheme in 2015-2016. Aim: To investigate whether the effects of the Quality Premium (QP), which provided performancerelated financial incentives to clinical commissioning groups (CCGs), could be explained by practice characteristics that contribute to variations in antibiotic prescribing. Design & setting: Longitudinal monthly prescribing data were analysed for 6251 primary care practices in England from April 2014 to March 2016. Method: Linear generalised estimating equations models were fitted, examining the effect of the 2015-2016 QP on the number of antibiotic items per specific therapeutic group age-sex related prescribing unit (STAR-PU) prescribed, adjusting for seasonality and months since implementation. Consistency of effects after further adjustment for variations in practice characteristics were also examined, including practice workforce, comorbidities prevalence, prescribing rates of non-antibiotic drugs, and deprivation. Results: Antibiotics prescribed in primary care practices in England reduced by -0.172 items per STAR-PU (95% confidence interval [CI] = -0.180 to -0.171) after 2015-2016 QP implementation, with slight increases in the months following April 2015 (+0.014 items per STAR-PU; 95% CI = +0.013 to +0.014). Adjusting the model for practice characteristics, the immediate and month-on-month effects following implementation remained consistent, with slight attenuation in immediate reduction from -0.172 to -0.166 items per STAR-PU. In subgroup analysis, the QP effect was significantly greater among the top 20% prescribing practices (interaction p<0.001). Practices with low workforce and those with higher diabetes prevalence had greater reductions in prescribing following 2015-2016 QP compared with other practices (interaction p<0.001). Conclusion: In high-prescribing practices, those with low workforce and high diabetes prevalence had more reduction following the QP compared with other practices, highlighting the need for targeted support of these practices and appropriate resourcing of primary care.

Anti-bacterial agents, Financial incentive, General practice, Primary health care, Quality premium, Resistance
0960-1643
Anyanwu, Philip
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Pouwels, Koen B.
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Walker, Anne
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Moore, Michael
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Majeed, Azeem
856bd09f-2a1e-46c0-9377-e40c825fbaaf
Hayhoe, Benedict
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Tonkin-Crine, Sarah
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Borek, Aleksandra
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Hopkins, Susan
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Mcleod, Monsey
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Costelloe, Céire
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Anyanwu, Philip
d60401e4-78a4-4942-a111-ba27641feb47
Pouwels, Koen B.
0f98f313-4c0b-42d9-9a50-183d32005db3
Walker, Anne
d8ff8e9d-e084-4f1d-aa96-feb8039de226
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Majeed, Azeem
856bd09f-2a1e-46c0-9377-e40c825fbaaf
Hayhoe, Benedict
15e3e895-e88f-4517-8dbf-f36501b2a052
Tonkin-Crine, Sarah
453132bf-d8a2-41c5-999d-cb2fcfb45239
Borek, Aleksandra
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Hopkins, Susan
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Mcleod, Monsey
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Costelloe, Céire
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Anyanwu, Philip, Pouwels, Koen B., Walker, Anne, Moore, Michael, Majeed, Azeem, Hayhoe, Benedict, Tonkin-Crine, Sarah, Borek, Aleksandra, Hopkins, Susan, Mcleod, Monsey and Costelloe, Céire (2020) Investigating the mechanism of impact and differential effect of the Quality Premium scheme on antibiotic prescribing in England: a longitudinal study. British Journal of General Practice, 4 (3), [bjgpopen20X101052]. (doi:10.3399/bjgpopen20X101052).

Record type: Article

Abstract

Background: In 2017, approximately 73% of antibiotics in England were prescribed from primary care practices. It has been estimated that 9%-23% of antibiotic prescriptions between 2013 and 2015 were inappropriate. Reducing antibiotic prescribing in primary care was included as one of the national priorities in a financial incentive scheme in 2015-2016. Aim: To investigate whether the effects of the Quality Premium (QP), which provided performancerelated financial incentives to clinical commissioning groups (CCGs), could be explained by practice characteristics that contribute to variations in antibiotic prescribing. Design & setting: Longitudinal monthly prescribing data were analysed for 6251 primary care practices in England from April 2014 to March 2016. Method: Linear generalised estimating equations models were fitted, examining the effect of the 2015-2016 QP on the number of antibiotic items per specific therapeutic group age-sex related prescribing unit (STAR-PU) prescribed, adjusting for seasonality and months since implementation. Consistency of effects after further adjustment for variations in practice characteristics were also examined, including practice workforce, comorbidities prevalence, prescribing rates of non-antibiotic drugs, and deprivation. Results: Antibiotics prescribed in primary care practices in England reduced by -0.172 items per STAR-PU (95% confidence interval [CI] = -0.180 to -0.171) after 2015-2016 QP implementation, with slight increases in the months following April 2015 (+0.014 items per STAR-PU; 95% CI = +0.013 to +0.014). Adjusting the model for practice characteristics, the immediate and month-on-month effects following implementation remained consistent, with slight attenuation in immediate reduction from -0.172 to -0.166 items per STAR-PU. In subgroup analysis, the QP effect was significantly greater among the top 20% prescribing practices (interaction p<0.001). Practices with low workforce and those with higher diabetes prevalence had greater reductions in prescribing following 2015-2016 QP compared with other practices (interaction p<0.001). Conclusion: In high-prescribing practices, those with low workforce and high diabetes prevalence had more reduction following the QP compared with other practices, highlighting the need for targeted support of these practices and appropriate resourcing of primary care.

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Accepted/In Press date: 16 February 2020
e-pub ahead of print date: 14 July 2020
Published date: August 2020
Additional Information: Copyright © 2020, The Authors.
Keywords: Anti-bacterial agents, Financial incentive, General practice, Primary health care, Quality premium, Resistance

Identifiers

Local EPrints ID: 438325
URI: http://eprints.soton.ac.uk/id/eprint/438325
ISSN: 0960-1643
PURE UUID: e501acba-4550-40e8-bf42-649eb443ed06
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509

Catalogue record

Date deposited: 05 Mar 2020 17:30
Last modified: 09 Jan 2022 07:49

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Contributors

Author: Philip Anyanwu
Author: Koen B. Pouwels
Author: Anne Walker
Author: Michael Moore ORCID iD
Author: Azeem Majeed
Author: Benedict Hayhoe
Author: Sarah Tonkin-Crine
Author: Aleksandra Borek
Author: Susan Hopkins
Author: Monsey Mcleod
Author: Céire Costelloe

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