Reducing antibiotic prescribing in primary care in England from 2014 to 2017: population-based cohort study
Objective To analyse individual-patient electronic health records to evaluate changes in antibiotic (AB) prescribing in England for different age groups, for male and female subjects, and by prescribing indications from 2014 to 2017.Methods Data were analysed for 102 general practices in England tha...
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BMJ Publishing Group
2019-07-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/7/e023989.full |
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| author | Xiaohui Sun Martin C Gulliford |
| author_facet | Xiaohui Sun Martin C Gulliford |
| author_sort | Xiaohui Sun |
| collection | DOAJ |
| description | Objective To analyse individual-patient electronic health records to evaluate changes in antibiotic (AB) prescribing in England for different age groups, for male and female subjects, and by prescribing indications from 2014 to 2017.Methods Data were analysed for 102 general practices in England that contributed data to the UK Clinical Practice Research Datalink (CPRD) from 2014 to 2017. Prescriptions for all ABs and for broad-spectrum β-lactam ABs were evaluated. Relative rate reductions (RRR) were estimated from a random-effects Poisson model, adjusting for age, gender, and general practice.Results Total AB prescribing declined from 608 prescriptions per 1000 person-years in 2014 to 489 per 1000 person-years in 2017; RRR 6.9% (95% CI 6.6% to 7.1%) per year. Broad-spectrum β-lactam AB prescribing decreased from 221 per 1000 person-years in 2014 to 163 per 1000 person-years in 2017; RRR 9.3% (9.0% to 9.6%) per year. Declines in AB prescribing were similar for men and women but the rate of decline was lower over the age of 55 years than for younger patients. All AB prescribing declined by 9.8% (9.6% to 10.1%) per year for respiratory infections, 5.7% (5.2% to 6.2%) for genitourinary infections, but by 3.8% (3.1% to 4.5%) for no recorded indication. Overall, 38.8% of AB prescriptions were associated with codes that did not suggest specific clinical conditions, and 15.3% of AB prescriptions had no medical codes recorded.Conclusion Antibiotic prescribing has reduced and become more selective but substantial unnecessary AB use may persist. Improving the quality of diagnostic coding for AB use will help to support antimicrobial stewardship efforts. |
| format | Article |
| id | doaj-art-b9fa1a022dc4473db89a704b6289d752 |
| institution | DOAJ |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-07-01 |
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| spelling | doaj-art-b9fa1a022dc4473db89a704b6289d7522025-08-20T02:50:29ZengBMJ Publishing GroupBMJ Open2044-60552019-07-019710.1136/bmjopen-2018-023989Reducing antibiotic prescribing in primary care in England from 2014 to 2017: population-based cohort studyXiaohui Sun0Martin C Gulliford12School of Public Health, Zhejiang Chinese Medical University, ChinaKing`s College London, UK, London, UKObjective To analyse individual-patient electronic health records to evaluate changes in antibiotic (AB) prescribing in England for different age groups, for male and female subjects, and by prescribing indications from 2014 to 2017.Methods Data were analysed for 102 general practices in England that contributed data to the UK Clinical Practice Research Datalink (CPRD) from 2014 to 2017. Prescriptions for all ABs and for broad-spectrum β-lactam ABs were evaluated. Relative rate reductions (RRR) were estimated from a random-effects Poisson model, adjusting for age, gender, and general practice.Results Total AB prescribing declined from 608 prescriptions per 1000 person-years in 2014 to 489 per 1000 person-years in 2017; RRR 6.9% (95% CI 6.6% to 7.1%) per year. Broad-spectrum β-lactam AB prescribing decreased from 221 per 1000 person-years in 2014 to 163 per 1000 person-years in 2017; RRR 9.3% (9.0% to 9.6%) per year. Declines in AB prescribing were similar for men and women but the rate of decline was lower over the age of 55 years than for younger patients. All AB prescribing declined by 9.8% (9.6% to 10.1%) per year for respiratory infections, 5.7% (5.2% to 6.2%) for genitourinary infections, but by 3.8% (3.1% to 4.5%) for no recorded indication. Overall, 38.8% of AB prescriptions were associated with codes that did not suggest specific clinical conditions, and 15.3% of AB prescriptions had no medical codes recorded.Conclusion Antibiotic prescribing has reduced and become more selective but substantial unnecessary AB use may persist. Improving the quality of diagnostic coding for AB use will help to support antimicrobial stewardship efforts.https://bmjopen.bmj.com/content/9/7/e023989.full |
| spellingShingle | Xiaohui Sun Martin C Gulliford Reducing antibiotic prescribing in primary care in England from 2014 to 2017: population-based cohort study BMJ Open |
| title | Reducing antibiotic prescribing in primary care in England from 2014 to 2017: population-based cohort study |
| title_full | Reducing antibiotic prescribing in primary care in England from 2014 to 2017: population-based cohort study |
| title_fullStr | Reducing antibiotic prescribing in primary care in England from 2014 to 2017: population-based cohort study |
| title_full_unstemmed | Reducing antibiotic prescribing in primary care in England from 2014 to 2017: population-based cohort study |
| title_short | Reducing antibiotic prescribing in primary care in England from 2014 to 2017: population-based cohort study |
| title_sort | reducing antibiotic prescribing in primary care in england from 2014 to 2017 population based cohort study |
| url | https://bmjopen.bmj.com/content/9/7/e023989.full |
| work_keys_str_mv | AT xiaohuisun reducingantibioticprescribinginprimarycareinenglandfrom2014to2017populationbasedcohortstudy AT martincgulliford reducingantibioticprescribinginprimarycareinenglandfrom2014to2017populationbasedcohortstudy |