Antibiotic prescribing for acute otitis media and acute sinusitis: a cross-sectional analysis of the ReCEnT study exploring the habits of early career doctors in family practice

ObjectivesTo explore the causes of the gender gap in antibiotic prescribing, and to determine whether women are more likely than men to receive an antibiotic prescription per consultation.DesignCross-sectional analysis of routinely collected electronic medical records from The Health Improvement Network (THIN).SettingEnglish primary care.ParticipantsPatients who consulted general practices registered with THIN between 2013 and 2015.Primary and secondary outcome measuresTotal antibiotic prescribing was measured in children (<19 years), adults (19–64 years) and the elderly (65+ years). For 12 common conditions, the number of adult consultations was measured, and the relative risk (RR) of being prescribed antibiotics when consulting as female or with comorbidity was estimated.ResultsAmong 4.57 million antibiotic prescriptions observed in the data, female patients received 67% more prescriptions than male patients, and 43% more when excluding antibiotics used to treat urinary tract infection (UTI). These gaps were more pronounced in adult women (99% more prescriptions than men; 69% more when excluding UTI) than in children (9%; 0%) or the elderly (67%; 38%). Among adults, women accounted for 64% of consultations (62% among patients with comorbidity), but were not substantially more likely than men to receive an antibiotic prescription when consulting with common conditions such as cough (RR 1.01; 95% CI 1.00 to 1.02), sore throat (RR 1.01, 95% CI 1.00 to 1.01) and lower respiratory tract infection (RR 1.00, 95% CI 1.00 to 1.01). Exceptions were skin conditions: women were less likely to be prescribed antibiotics when consulting with acne (RR 0.67, 95% CI 0.66 to 0.69) or impetigo (RR 0.85, 95% CI 0.81 to 0.88).ConclusionsThe gender gap in antibiotic prescribing can largely be explained by consultation behaviour. Although in most cases adult men and women are equally likely to be prescribed an antibiotic when consulting primary care, it is unclear whether or not they are equally indicated for antibiotic therapy.

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Antibiotic stewardship in skin infections: a cross-sectional analysis of early-career GP’s management of impetigo

BMJ Open ◽

10.1136/bmjopen-2019-031527 ◽

2019 ◽

Vol 9 (10) ◽

pp. e031527 ◽

Cited By ~ 1

Author(s):

Clare Heal ◽

Hilary Gorges ◽

Mieke L van Driel ◽

Amanda Tapley ◽

Josh Davis ◽

...

Keyword(s):

Antibiotic Prescription ◽

Early Career ◽

Cross Sectional ◽

Topical Antibiotics ◽

Systemic Antibiotic ◽

Cross Sectional Analysis ◽

Clinical Encounters ◽

New Diagnosis ◽

Sectional Analysis ◽

Systemic Antibiotics

ObjectiveTo establish the prevalence and associations of systemic antibiotic prescription for impetigo by early-career general practitioners (GPs) (GP registrars in their first 18 months in general practice).DesignA cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study.SettingReCEnT is an ongoing multisite cohort study of Australian registrars’ in-consultation clinical practice across five Australian states.ParticipantsRegistrars participating in ReCEnT from 2010 to 2017.Outcome measuresManagement of impetigo with systemic antibiotics.Results1741 registrars (response rate 96%) provided data from 384 731 problems identified in 246 434 consultations. Impetigo, on first presentation or follow-up, was managed in 930 (0.38%, 95% CI 0.35 to 0.40) consultations and comprised 0.24% (95% CI 0.23 to 0.26) of problems. 683 patients presented with a new diagnosis of impetigo of which 38/683 (5.6%) were not prescribed antibiotics; 239/683 (35.0%) were prescribed solely topical antibiotics; 306/683 (44.8%) solely systemic antibiotics and 100/683 (14.6%) both systemic and topical antibiotics. The most common systemic antibiotic prescribed was cephalexin (53.5%). Variables independently associated with prescription of systemic antibiotics were an inner regional (compared with major city) location (OR 1.82, 95% CI 1.06 to 3.13; p=0.028), seeking in-consultation information or advice (OR 2.17, 95% CI 1.47 to 3.23; p<0.001) and ordering pathology (OR 2.13, 95% CI 1.37 to 3.33; p=0.01).ConclusionsAustralian early-career GPs prescribe systemic antibiotics (the majority broad-spectrum) for a high proportion of initial impetigo presentations. Impetigo guidelines should clearly specify criteria for systemic antibiotic prescription and individual antibiotic choice. The role of non-antibiotic management and topical antiseptics needs to be explored further.

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Antibiotic prescribing and patient satisfaction in primary care in England: cross-sectional analysis of national patient survey data and prescribing data

BDJ ◽

10.1038/sj.bdj.2016.51 ◽

2016 ◽

Vol 220 (2) ◽

pp. 57-57

Keyword(s):

Primary Care ◽

Patient Satisfaction ◽

Survey Data ◽

Patient Survey ◽

Antibiotic Prescribing ◽

Cross Sectional ◽

Cross Sectional Analysis ◽

National Patient ◽

Sectional Analysis

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A cross-sectional analysis of otitis media with effusion in children with Down syndrome

European Journal of Pediatrics ◽

10.1007/s00431-014-2323-5 ◽

2014 ◽

Vol 173 (10) ◽

pp. 1319-1325 ◽

Cited By ~ 21

Author(s):

M. Maris ◽

M. Wojciechowski ◽

P. Van de Heyning ◽

An Boudewyns

Keyword(s):

Down Syndrome ◽

Otitis Media ◽

Otitis Media With Effusion ◽

Cross Sectional ◽

Children With Down Syndrome ◽

Cross Sectional Analysis ◽

Sectional Analysis

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Prescription of antibiotics to children with acute otitis media in Danish general practice

10.21203/rs.3.rs-18177/v3 ◽

2020 ◽

Author(s):

Jonas Olsen ◽

Jesper Lykkegaard ◽

Malene Plejdrup Hansen ◽

Frans B Waldorff ◽

Jørgen Lous ◽

...

Keyword(s):

General Practice ◽

Otitis Media ◽

Acute Otitis Media ◽

Acute Respiratory Tract Infection ◽

Winter Period ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Cross Sectional ◽

Clinical Criteria ◽

General Practices

Abstract Background: Acute otitis media (AOM) is a common and most often self-limiting infection in childhood, usually managed in general practice. Even though antibiotics are only recommended when certain diagnostic and clinical criteria are met a high antibiotic prescription rate is observed. The study’s objective was to analyse associations between patient- and general practitioner (GP) characteristics and antibiotic prescribing for children with AOM in an effort to explain the high antibiotic prescribing rates.Methods: All general practices in the Northern, Southern and Central regions of Denmark were invited to record symptoms, examinations, findings and antibiotic treatment for all children ≤ 7 years of age diagnosed with AOM during a four-week winter period in 2017/2018. Associations were analysed by means of multivariate logistic regressions. The study design was cross-sectional. Results: GPs from 60 general practices diagnosed 278 children with AOM of whom 207 (74%) were prescribed antibiotics, most often penicillin V (60%). About half of the children had tympanometry performed. Antibiotic prescribing rates varied considerably between practices (0-100%). Antibiotic prescribing was associated with fever (odds ratio (OR) 3.69 95% confidence interval (CI) 1.93-7.05), purulent ear secretion (OR 2.35 95% CI 1.01-5.50) and poor general condition (OR 3.12 95% CI 1.31-7.46), and the practice’s antibiotic prescribing rate to other patients with symptoms of an acute respiratory tract infection (OR 2.85 CI 95% 1.07-7.60) and specifically to other children with AOM (OR 4.15 CI 95% 1.82-9.47).Conclusion: GPs’ antibiotic prescribing rates for children with AOM vary considerably even considering the of signs, symptoms, request for antibiotics, and use of tympanometry. Interventions to reduce overprescribing should be targeted high-prescribing practices.

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Early career GPs, mental health training and clinical complexity: a cross-sectional analysis

Education for Primary Care ◽

10.1080/14739879.2018.1551070 ◽

2018 ◽

Vol 30 (2) ◽

pp. 62-69

Author(s):

Louise Stone ◽

Amanda Tapley ◽

Jennifer Presser ◽

Elizabeth Holliday ◽

Jean Ball ◽

...

Keyword(s):

Mental Health ◽

Early Career ◽

Mental Health Training ◽

Cross Sectional ◽

Health Training ◽

Cross Sectional Analysis ◽

Clinical Complexity ◽

Sectional Analysis

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Prescription of antibiotics to children with acute otitis media in Danish general practice

10.21203/rs.3.rs-18177/v2 ◽

2020 ◽

Author(s):

Jonas Olsen ◽

Jesper Lykkegaard ◽

Malene Plejdrup Hansen ◽

Frans B Waldorff ◽

Jørgen Lous ◽

...

Keyword(s):

General Practice ◽

Otitis Media ◽

Acute Otitis Media ◽

Acute Respiratory Tract Infection ◽

Winter Period ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Cross Sectional ◽

Clinical Criteria ◽

General Practices

Abstract Background: Acute otitis media (AOM) is a common and most often self-limiting infection in childhood, usually managed in general practice. Even though antibiotics are only recommended when certain diagnostic and clinical criteria are met a high antibiotic prescription rate is observed. The study’s objective was to analyse associations between patient- and general practitioner (GP) characteristics and antibiotic prescribing for children with AOM in an effort to explain the high antibiotic prescribing rates. Methods: All general practices in the Northern, Southern and Central regions of Denmark were invited to record symptoms, examinations, findings and antibiotic treatment for all children ≤ 7 years of age diagnosed with AOM during a four-week winter period in 2017/2018. Associations were analysed by means of multivariate logistic regressions. The study design was cross-sectional. Results: GPs from 60 general practices diagnosed 278 children with AOM of whom 207 (74%) were prescribed antibiotics, most often penicillin V (60%). About half of the children had tympanometry performed. Antibiotic prescribing rates varied considerably between practices (0-100%). Antibiotic prescribing was associated with fever (odds ratio (OR) 3.69 95% confidence interval (CI) 1.93-7.05), purulent ear secretion (OR 2.35 95% CI 1.01-5.50) and poor general condition (OR 3.12 95% CI 1.31-7.46), and the practice’s antibiotic prescribing rate to other patients with symptoms of an acute respiratory tract infection (OR 2.85 CI 95% 1.07-7.60) and specifically to other children with AOM (OR 4.15 CI 95% 1.82-9.47). Conclusion: GPs’ antibiotic prescribing rates for children with AOM vary considerably even considering the of signs, symptoms, request for antibiotics, and use of tympanometry. Interventions to reduce overprescribing should be targeted high-prescribing practices.

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Antibiotic prescribing patterns of general practice registrars for infective conjunctivitis: a cross-sectional analysis

Journal of Primary Health Care ◽

10.1071/hc20040 ◽

2021 ◽

Vol 13 (1) ◽

pp. 5

Author(s):

Marcus D. Cherry ◽

Amanda Tapley ◽

Debbie Quain ◽

Elizabeth G. Holliday ◽

Jean Ball ◽

...

Keyword(s):

General Practice ◽

Clinical Training ◽

Antibiotic Prescription ◽

Prescribing Patterns ◽

Antibiotic Prescribing ◽

Cross Sectional ◽

Cross Sectional Analysis ◽

Sectional Analysis ◽

Registrar Training

ABSTRACT INTRODUCTIONOver-prescription of antibiotics for common infective conditions is an important health issue. Infective conjunctivitis represents one of the most common eye-related complaints in general practice. Despite its self-limiting nature, there is evidence of frequent general practitioner (GP) antibiotic prescribing for this condition, which is inconsistent with evidence-based guidelines. AIMTo investigate the prevalence and associations of GP registrars’ (trainees’) prescription of antibiotics for infective conjunctivitis. METHODSWe performed a cross-sectional analysis of the Registrar Encounters in Clinical Training (ReCEnT) ongoing prospective cohort study, which documents GP registrars’ clinical consultations (involving collection of information from 60 consecutive consultations, at three points during registrar training). The outcome of the analyses was antibiotic prescription for a new diagnosis of conjunctivitis. Patient, registrar, practice and consultation variables were included in uni- and multivariable logistic regression analyses to test associations of these prescriptions. RESULTSIn total, 2333 registrars participated in 18 data collection rounds from 2010 to 2018. There were 1580 new cases of infective conjunctivitis (0.31% of all problems). Antibiotics (mainly topical) were prescribed in 1170 (74%) of these cases. Variables associated with antibiotic prescription included patients’ Aboriginal or Torres Strait Islander status, registrar organisation of a follow up (both registrar and other GP follow up), and earlier registrar training term (more junior status). DISCUSSIONGP registrars, like established GPs, prescribe antibiotics for conjunctivitis in excess of guideline recommendations, but prescribing rates are lower in later training. These prescribing patterns have educational, social and economic consequences. Further educational strategies may enhance attenuation of registrars’ prescribing during training.

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