scholarly journals 1345. Impact of the COVID-19 Pandemic on Pediatric Ambulatory Antibiotic Use in an Academic Health System

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S683-S684
Author(s):  
Sophie E Katz ◽  
Hillary Spencer ◽  
Jim Zhang ◽  
Ritu Banerjee ◽  
Ritu Banerjee
Keyword(s):  
Primary Care ◽  
Antibiotic Prescription ◽  
Medical Center ◽  
Antibiotic Use ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Provider Type ◽  
Prescription Rates ◽  
Student’S T ◽  
Almost All

Abstract Background It is unclear how the COVID-19 pandemic has impacted outpatient pediatric antibiotic prescribing. Methods We compared diagnoses and antibiotic prescription rates for children pre- vs post-COVID-19 in 5 ambulatory settings affiliated with Vanderbilt University Medical Center: emergency department (ED), urgent care clinics (including pediatric-only after-hours clinics [AHC]s and walk-in clinics [WIC] for all ages), primary care clinics (PCC), and retail health clinics (RHC). Time periods were pre-COVID-19 3/1/19 – 5/15/19 (P1); and post-COVID-19 3/1/20 – 5/15/20 (P2). Diagnoses and percent of encounters with an antibiotic prescription were analyzed by encounter (in-person vs telemedicine [TMed]), clinic and provider type. We also interviewed 16 providers about perceived COVID-19 impact on pediatric ambulatory antibiotic prescribing. Student’s T and χ 2 tests were used as appropriate. Results The number of pediatric ambulatory visits was 16671 in P1 and 7010 in P2. There were no TMed visits in P1 vs 188 in P2 (2.7% of total P2 visits); 186 (99% of TMed visits) were in PCC (Table). In all settings, the number of encounters was lower in P2 vs P1 (p< 0.001). The percent of encounters with an antibiotic prescription was lower in P2 (32%) than in P1 (38.2%) (p< 0.001) (Table) overall and in all settings except RHCs. Only 14 (7.4%) TMed visits resulted in an antibiotic prescription. There were no differences in antibiotic prescribing rates by provider type. Diagnoses varied significantly between periods in all clinic types except the ED, with noninfectious diagnoses being higher in P2 vs P1 (Figure 1). Providers felt that COVID-19 led to fewer but sicker patients presenting for care, and variable impact on antibiotic prescribing (Figure 2). Table. Percent of Encounters with an Antibiotic by Clinic Type, Pre- and Post-COVID-19 Figure 1. Diagnosis Rates by Clinic Type, Pre- and Post-COVID-19 Figure 2. Themes from Provider Interviews about perceived Impact of COVID-19 on Clinician Practice Conclusion The proportion of encounters with non-infectious diagnoses increased and antibiotic prescribing rates decreased significantly in all pediatric ambulatory settings post-COVID-19 except RHCs. Almost all TMed encounters occurred in the primary care setting, and few resulted in an antibiotic prescription. Providers felt they saw fewer patients and higher acuity of illness post COVID-19. Disclosures Hillary Spencer, MD, MPH, NIH (T32 grant support) (Grant/Research Support)

scholarly journals Impact of the COVID-19 Pandemic on Antibiotic Prescribing for Common Infections in The Netherlands: A Primary Care-Based Observational Cohort Study

Antibiotics ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 196
Author(s):  
Alma C. van de Pol ◽  
Josi A. Boeijen ◽  
Roderick P. Venekamp ◽  
Tamara Platteel ◽  
Roger A. M. J. Damoiseaux ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Primary Care ◽  
Health Care ◽  
Antibiotic Prescription ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Skin Infections ◽  
Prescription Rates ◽  
Ear Infections ◽  
Disease Entities

In 2020, the COVID-19 pandemic brought dramatic changes in the delivery of primary health care across the world, presumably changing the number of consultations for infectious diseases and antibiotic use. We aimed to assess the impact of the pandemic on infections and antibiotic prescribing in Dutch primary care. All patients included in the routine health care database of the Julius General Practitioners’ Network were followed from March through May 2019 (n = 389,708) and March through May 2020 (n = 405,688). We extracted data on consultations for respiratory/ear, urinary tract, gastrointestinal and skin infections using the International Classification of Primary Care (ICPC) codes. These consultations were combined in disease episodes and linked to antibiotic prescriptions. The numbers of infectious disease episodes (total and those treated with antibiotics), complications, and antibiotic prescription rates (i.e., proportion of episodes treated with antibiotics) were calculated and compared between the study periods in 2019 and 2020. Fewer episodes were observed during the pandemic months than in the same months in 2019 for both the four infectious disease entities and complications such as pneumonia, mastoiditis and pyelonephritis. The largest decline was seen for gastrointestinal infections (relative risk (RR), 0.54; confidence interval (CI), 0.51 to 0.58) and skin infections (RR, 0.71; CI, 0.67 to 0.75). The number of episodes treated with antibiotics declined as well, with the largest decrease seen for respiratory/ear infections (RR, 0.54; CI, 0.52 to 0.58). The antibiotic prescription rate for respiratory/ear infections declined from 21% to 13% (difference −8.0% (CI, −8.8 to −7.2)), yet the prescription rates for other infectious disease entities remained similar or increased slightly. The decreases in primary care infectious disease episodes and antibiotic use were most pronounced in weeks 15–19, mid-COVID-19 wave, after an initial peak in respiratory/ear infection presentation in week 11, the first week of lock-down. In conclusion, our findings indicate that the COVID-19 pandemic has had profound effects on the presentation of infectious disease episodes and antibiotic use in primary care in the Netherlands. Consequently, the number of infectious disease episodes treated with antibiotics decreased. We found no evidence of an increase in complications.

scholarly journals Changing antibiotic prescribing practices in outpatient primary care settings in China: Study protocol for a health information system-based cluster-randomised crossover controlled trial

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0259065
Author(s):  
Yue Chang ◽  
Yuanfan Yao ◽  
Zhezhe Cui ◽  
Guanghong Yang ◽  
Duan Li ◽  
...  
Keyword(s):  
Primary Care ◽  
Antibiotic Prescription ◽  
Intervention Group ◽  
Control Group ◽  
Antibiotic Prescribing ◽  
Prescription Rate ◽  
Feedback Intervention ◽  
Primary Care Settings ◽  
Cluster Randomised ◽  
Prescription Rates

Background The overuse and abuse of antibiotics is a major risk factor for antibiotic resistance in primary care settings of China. In this study, the effectiveness of an automatically-presented, privacy-protecting, computer information technology (IT)-based antibiotic feedback intervention will be evaluated to determine whether it can reduce antibiotic prescribing rates and unreasonable prescribing behaviours. Methods We will pilot and develop a cluster-randomised, open controlled, crossover, superiority trial. A total of 320 outpatient physicians in 6 counties of Guizhou province who met the standard will be randomly divided into intervention group and control group with a primary care hospital being the unit of cluster allocation. In the intervention group, the three components of the feedback intervention included: 1. Artificial intelligence (AI)-based real-time warnings of improper antibiotic use; 2. Pop-up windows of antibiotic prescription rate ranking; 3. Distribution of educational manuals. In the control group, no form of intervention will be provided. The trial will last for 6 months and will be divided into two phases of three months each. The two groups will crossover after 3 months. The primary outcome is the 10-day antibiotic prescription rate of physicians. The secondary outcome is the rational use of antibiotic prescriptions. The acceptability and feasibility of this feedback intervention study will be evaluated using both qualitative and quantitative assessment methods. Discussion This study will overcome limitations of our previous study, which only focused on reducing antibiotic prescription rates. AI techniques and an educational intervention will be used in this study to effectively reduce antibiotic prescription rates and antibiotic irregularities. This study will also provide new ideas and approaches for further research in this area. Trial registration ISRCTN, ID: ISRCTN13817256. Registered on 11 January 2020.

Community antibiotic prescribing for children in France from 2015 to 2017: a cross-sectional national study

2020 ◽  
Author(s):  
Nhung T H Trinh ◽  
Robert Cohen ◽  
Magali Lemaitre ◽  
Pierre Chahwakilian ◽  
Gregory Coulthard ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Antibiotic Prescription ◽  
Antibiotic Use ◽  
National Study ◽  
Antibiotic Prescribing ◽  
Broad Spectrum Antibiotic ◽  
Duration Of Treatment ◽  
Cross Sectional ◽  
Prescription Rates ◽  
Tract Infections

Abstract Objectives To assess recent community antibiotic prescribing for French children and identify areas of potential improvement. Methods We analysed 221 768 paediatric (<15 years) visits in a national sample of 680 French GPs and 70 community paediatricians (IQVIA’s EPPM database), from March 2015 to February 2017, excluding well-child visits. We calculated antibiotic prescription rates per 100 visits, separately for GPs and paediatricians. For respiratory tract infections (RTIs), we described broad-spectrum antibiotic use and duration of treatment. We used Poisson regression to identify factors associated with antibiotic prescribing. Results GPs prescribed more antibiotics than paediatricians [prescription rate 26.1 (95% CI 25.9–26.3) versus 21.6 (95% CI 21.0–22.2) per 100 visits, respectively; P < 0.0001]. RTIs accounted for more than 80% of antibiotic prescriptions, with presumed viral RTIs being responsible for 40.8% and 23.6% of all antibiotic prescriptions by GPs and paediatricians, respectively. For RTIs, antibiotic prescription rates per 100 visits were: otitis, 68.1 and 79.8; pharyngitis, 67.3 and 53.3; sinusitis, 67.9 and 77.3; pneumonia, 80.0 and 99.2; bronchitis, 65.2 and 47.3; common cold, 21.7 and 11.6; bronchiolitis 31.6 and 20.1; and other presumed viral RTIs, 24.1 and 11.0, for GPs and paediatricians, respectively. For RTIs, GPs prescribed more broad-spectrum antibiotics [49.8% (95% CI 49.3–50.3) versus 35.6% (95% CI 34.1–37.1), P < 0.0001] and antibiotic courses of similar duration (P = 0.21). After adjustment for diagnosis, antibiotic prescription rates were not associated with season and patient age, but were significantly higher among GPs aged ≥50 years. Conclusions Future antibiotic stewardship campaigns should target presumed viral RTIs, broad-spectrum antibiotic use and GPs aged ≥50 years.

scholarly journals Antibiotic prescription in primary care from the perspective of family physicians: a qualitative study

2021 ◽  
Vol 15 (08) ◽  
pp. 1117-1123
Author(s):  
Salih Hosoglu ◽  
Annika Yanina Classen ◽  
Zekeriya Akturk
Keyword(s):  
Primary Care ◽  
Social Status ◽  
Antibiotic Prescription ◽  
Public Awareness ◽  
Family Physicians ◽  
Antibiotic Use ◽  
Patient Expectations ◽  
Medical Decision ◽  
Antibiotic Prescribing ◽  
The Social

Introduction: Antibiotic consumption increases worldwide steadily. Turkey is now top on the list of global consumption and became a prototype of excessive use of antibiotics. In the last two decades, family physicians (FPs) have become key figures in the healthcare system. This study aims to understand the reasons for inappropriate antibiotic prescribing and elicit suggestions for improving antibiotic use in primary care from doctors themselves. Methodology: This is a qualitative semi-structured interview study with research dialogues guided by the Vancouver School of interpretive phenomenology. Fourteen FPs from different parts of Turkey were questioned on inappropriate antibiotic prescriptions and their suggestions for improving antibiotic use. Results: The most important reasons for prescribing antibiotics without acceptable indications were patient expectations, defensive medical decision making, constraints due to workload, and limited access to laboratories. The most remarkable inference was the personal feeling of an insecure job environment of the FPs. The most potent suggestions for improving the quality of antibiotic prescription were public campaigns, improvements in the diagnostic infrastructures of primary care centers, and enhancing the social status of FPs. The FPs expressed strong concerns related to the complaints that patients make to administrative bodies. Conclusions: Primary care physicians work under immense pressure, stemming mainly from workload, patient expectations, and obstacles related to diagnostic processes. Improving the social status of physicians, increasing public awareness, and the facilitation of diagnostic procedures was the methods suggested for increasing antibiotic prescription accuracy.

scholarly journals 2069. A Unique Approach to Outpatient Antibiotic Stewardship in Rural Southern Ohio

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S697-S698
Author(s):  
Lara K Ramey ◽  
David K Byers ◽  
Eli DeLille
Keyword(s):  
Medical Center ◽  
Acute Bronchitis ◽  
Antibiotic Use ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Provider Education ◽  
Hospital System ◽  
Improvement Rate ◽  
Stewardship Program ◽  
National Quality

Abstract Background A five county rural community in southern Ohio was identified as having significantly higher than average rates of antibiotic use. The hospital system serving this area, Southern Ohio Medical Center (SOMC), began initial efforts in antimicrobial stewardship focusing on inpatient prescribing. However, most antimicrobial consumption occurs in the outpatient setting. Early attempts to improve antibiotic prescribing focused on only provider education and resulted in little change. Providers felt they were performing well, or their patients were more complex and prescribing the antibiotics was warranted. SOMC partnered with the state Quality Improvement Organization, HSAG, to design an intervention to address these challenges. Methods All outpatient and emergency room encounters with acute bronchitis and upper respiratory infection (URI) (ICD-10 codes [J00, J06.9, and J20.X]) were included in the analysis. Using criteria from a National Quality Forum measure, concomitant diagnoses were excluded to identify encounters where an associated condition may indicate the case is more complex. A 6-month baseline and two additional 6-month remeasurement periods were analyzed. Providers were given letters, peer-to-peer antimicrobial data comparison, and in-person feedback with guideline-driven recommendations for these conditions. Results Baseline analysis indicated 50% of all encounters without a coded concomitant diagnosis resulted in antibiotic prescriptions. There was a reduction in the overall rate at each remeasurement period, to 34% and then 12%. This resulted in a 76% relative improvement rate (RIR) overall at the final remeasurement period. At baseline, the highest volume setting, urgent care, had a prescribing rate of 71%. Urgent-care prescriptions reduced each remeasurement to 45% and 13%, resulting in an 81% RIR. Conclusion Implementing a robust outpatient stewardship program in a rural nonacademic setting is not without unique challenges. By using peer comparison of provider performance data on prescribing habits in uncomplicated patients with URI and acute bronchitis in addition to education, the rate of appropriate antibiotic use improved. Disclosures All authors: No reported disclosures.

scholarly journals Do NHS GP surgeries employing GPs additionally trained in integrative or complementary medicine have lower antibiotic prescribing rates? Retrospective cross-sectional analysis of national primary care prescribing data in England in 2016

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e020488 ◽  
Author(s):  
Esther T van der Werf ◽  
Lorna J Duncan ◽  
Paschen von Flotow ◽  
Erik W Baars
Keyword(s):  
Primary Care ◽  
Tract Infection ◽  
Negative Binomial ◽  
Antibiotic Prescription ◽  
Additional Treatment ◽  
Digital Data ◽  
Future Research ◽  
Antibiotic Prescribing ◽  
Cross Sectional ◽  
Prescription Rates

ObjectiveTo determine differences in antibiotic prescription rates between conventional General Practice (GP) surgeries and GP surgeries employing general practitioners (GPs) additionally trained in integrative medicine (IM) or complementary and alternative medicine (CAM) (referred to as IM GPs) working within National Health Service (NHS) England.DesignRetrospective study on antibiotic prescription rates per STAR-PU (Specific Therapeutic group Age–sex weighting Related Prescribing Unit) using NHS Digital data over 2016. Publicly available data were used on prevalence of relevant comorbidities, demographics of patient populations and deprivation scores.SettingPrimary Care.Participants7283 NHS GP surgeries in England.Primary outcome measureThe association between IM GPs and antibiotic prescribing rates per STAR-PU with the number of antibiotic prescriptions (total, and for respiratory tract infection (RTI) and urinary tract infection (UTI) separately) as outcome.ResultsIM GP surgeries (n=9) were comparable to conventional GP surgeries in terms of list sizes, demographics, deprivation scores and comorbidity prevalence. Negative binomial regression models showed that statistically significant fewer total antibiotics (relative risk (RR) 0.78, 95% CI 0.64 to 0.97) and RTI antibiotics (RR 0.74, 95% CI 0.59 to 0.94) were prescribed at NHS IM GP surgeries compared with conventional NHS GP surgeries. In contrast, the number of antibiotics prescribed for UTI were similar between both practices.ConclusionNHS England GP surgeries employing GPs additionally trained in IM/CAM have lower antibiotic prescribing rates. Accessibility of IM/CAM within NHS England primary care is limited. Main study limitation is the lack of consultation data. Future research should include the differences in consultation behaviour of patients self-selecting to consult an IM GP or conventional surgery, and its effect on antibiotic prescription. Additional treatment strategies for common primary care infections used by IM GPs should be explored to see if they could be used to assist in the fight against antimicrobial resistance.

The inconvincible patient: how clinicians perceive demand for antibiotics in the outpatient setting

2019 ◽  
Author(s):  
Mike R Kohut ◽  
Sara C Keller ◽  
Jeffrey A Linder ◽  
Pranita D Tamma ◽  
Sara E Cosgrove ◽  
...  
Keyword(s):  
Antibiotic Prescription ◽  
Antibiotic Use ◽  
Outpatient Setting ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Structured Interviews ◽  
Related Factors ◽  
Directed Content Analysis ◽  
The Face ◽  
Outpatient Settings

Abstract Background Perceived patient demand for antibiotics drives unnecessary antibiotic prescribing in outpatient settings, but little is known about how clinicians experience this demand or how this perceived demand shapes their decision-making. Objective To identify how clinicians perceive patient demand for antibiotics and the way these perceptions stimulate unnecessary prescribing. Methods Qualitative study using semi-structured interviews with clinicians in outpatient settings who prescribe antibiotics. Interviews were analyzed using conventional and directed content analysis. Results Interviews were conducted with 25 clinicians from nine practices across three states. Patient demand was the most common reason respondents provided for why they prescribed non-indicated antibiotics. Three related factors motivated clinically unnecessary antibiotic use in the face of perceived patient demand: (i) clinicians want their patients to regard clinical visits as valuable and believe that an antibiotic prescription demonstrates value; (ii) clinicians want to avoid negative repercussions of denying antibiotics, including reduced income, damage to their reputation, emotional exhaustion, and degraded relationships with patients; (iii) clinicians believed that certain patients are impossible to satisfy without an antibiotic prescription and felt that efforts to refuse antibiotics to such patients wastes time and invites the aforementioned negative repercussions. Clinicians in urgent care settings were especially likely to describe being motivated by these factors. Conclusion Interventions to improve antibiotic use in the outpatient setting must address clinicians’ concerns about providing value for their patients, fear of negative repercussions from denying antibiotics, and the approach to inconvincible patients.

scholarly journals 222. Comparison of Outpatient Antibiotic Prescriptions in a High Prescribing State, 2016–2018

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S112-S112
Author(s):  
Christopher D Evans ◽  
Youssoufou Ouedraogo ◽  
Amelia Keaton ◽  
Milner Staub
Keyword(s):  
Antibiotic Prescription ◽  
Group Analysis ◽  
Age Groups ◽  
Population Data ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Prescribing Trends ◽  
Amoxicillin Clavulanate ◽  
Prescription Rates ◽  
Outpatient Settings

Abstract Background About 80% of antibiotic prescriptions are written in outpatient settings. Outpatient antibiotic use (AU) is highest in the Southern United States. Tennessee consistently has one of the highest AU rates in the country. Previous analyses found that 1,195 prescriptions were filled in Tennessee per 1,000 total population in 2016. Moreover, 50% of all outpatient antibiotic prescriptions were written by 9.3% of prescribers. We sought to assess Tennessee outpatient antibiotic prescribing trends, comparing 2016 with 2018 data. Methods The Tennessee IQVIA outpatient antibiotic prescription dataset from January 1 to December 31, 2018 was analyzed and compared to 2016 results. Orally administered antibacterial agents were included. Patients < 20 years old were classified as pediatric. County level population data were obtained from the Tennessee Department of Health. Antibiotic prescription rates were calculated as antibiotics prescribed per 1,000 population in the specified age group. Analysis was performed using SAS 9.4. Results The statewide AU rate decreased from 1,195 in 2016 to 1,074 in 2018 per 1,000 population. Consistent with the previous analysis, female patients (1,288), those over 65 years (1,459), and those < 2 years (1,372) had the highest rates of AU in 2018. Lower rates were observed in all age groups in 2018 except for the 3–9 years group. While narrow penicillins and macrolides remain the most frequently prescribed antibiotics, amoxicillin-clavulanate and ciprofloxacin fell out of the top five antibiotics used in adults, and amoxicillin-clavulanate fell out of the top five antibiotics used in pediatrics. Similar to 2016, 9.2% (3,098) of the providers contributed to 50% of the total prescriptions in 2016, and 2,090 of the 2,994 (69.8%) 2016 highest prescribing providers were also among the highest prescribers in 2018. Conclusion Despite a decline in outpatient antibiotic prescription volume, Tennessee remains one of the nation’s highest prescribing states. While a decline in broad spectrum antibiotic prescriptions may indicate a shift to more appropriate usage, these data do not include indication, excluding appropriate use assessment. Identifying and focusing antibiotic stewardship interventions for consistently high prescribers remains a priority for Tennessee. Disclosures All Authors: No reported disclosures

scholarly journals Antibiotic Prescribing for Acute, Non-Complicated Infections in Primary Care in Germany: Baseline Assessment of in the Cluster Randomized Trial ARena

2021 ◽  
Author(s):  
Regina Poss-Doering ◽  
Dorothea Kronsteiner ◽  
Martina Kamradt ◽  
Edith Andres ◽  
Petra Kaufmann-Kolle ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Antibiotic Prescription ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Reference Groups ◽  
Rational Use ◽  
Prescription Rates ◽  
Rational Use Of Antibiotics ◽  
To Receive

Abstract BackgroundAntimicrobial resistance is fueled by inappropriate use of antibiotics. Global and national strategies support rational use of antibiotics to retain treatment options and reduce resistance. In Germany, the ARena project (Sustainable reduction of antibiotic-induced antimicrobial resistance) intended to promote rational use of antibiotics for acute non-complicated infections by addressing network-affiliated physicians, primary care teams and patients through multiple interacting interventions. The present study documented patterns of antibiotic prescribing for patients with acute non-complicated infections who consulted a physician in these networks at the start of the ARena project. It explored variation across subgroups of patients and draws comparisons to prescribing patterns of non-targeted physicians. MethodsThis retrospective cross-sectional analysis used mixed logistic regression models to explore factors associated with the primary outcome, which was the proportion of patients with acute non-complicated infections consulting primary care practices who received an antibiotic prescription. Secondary outcomes concerned the prescription of different types of antibiotics. Descriptive methods were used to summarize the data referring to targeted physicians in primary care networks, non-targeted physicians (reference groups), and patient subgroups. ResultsOverall, antibiotic prescription rates were 31.7% in reference groups and 32.0% in primary care networks. General practitioners prescribed antibiotics more frequently than other medical specialist groups (otolaryngologists vs. General practitioners OR=0.465 CI=[0.302; 0.719], p<0.001, pediatricians vs. General practitioners: OR=0.369 CI=[0.135; 1.011], p=0.053). Quinolone prescription rates were 8.1% in reference groups and 9.9% in primary care networks. Patients with comorbidities had a higher likelihood of receiving an antibiotic and quinolone prescription and were less likely to receive a guideline-recommended substance. Younger patients were less likely to receive antibiotics (OR=0.771 CI=[0.636; 0.933], p=0.008). Female gender was associated with higher rates of antibiotic prescriptions (OR=1.293 CI=[1.201, 1.392], p<0.001).Conclusion At the start of the ARena project, observed antibiotic prescription rates for acute non-complicated infections showed room for improvement. This clearly supports the need for the ARENA-Project.

scholarly journals Association between antibiotic prescribing and deprivation in Wales: A multilevel analysis

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Victor Adekanmbi ◽  
Ann Smith ◽  
Daniel Farewell ◽  
Hywel Jones ◽  
Shantini Paranjothy ◽  
...  
Keyword(s):  
Primary Care ◽  
Incidence Rate Ratio ◽  
Antibiotic Use ◽  
Socioeconomic Deprivation ◽  
Antibiotic Prescribing ◽  
Final Model ◽  
Class A ◽  
High Deprivation ◽  
Prescription Rates ◽  
Index Of Multiple Deprivation

IntroductionThe most recent Welsh Antimicrobial Resistance Programme (WARP) report on antibiotic use in primary care found significant variations between Health Boards and hospitals in gross antibiotic use in 2014. The aim of this study was to evaluate the association between socioeconomic deprivation and antibiotic prescribing volumes. Objectives and ApproachWelsh General Practitioner (GP) antibiotic prescribing data for years 2013 to 2016 for patients’ resident in Wales were extracted from the Secure Anonymised Information Linkage GP tables. Deprivation was assessed by linking prescribing events to the Welsh Index of Multiple Deprivation (WIMD) score for the patient’s neighbourhood area. The association between deprivation area and antibiotic prescribed (items per 1000 persons per day) was stratified according to the patient’s age, sex, prescription year and antibiotic class. A three-level multilevel Poisson regression model of 1.58 million patients nested within 349 GP practices, nested with 67 GP clusters, was specified to assess the associations ResultsJust over 7.97 million antibiotic items were prescribed between 2013 and 2016. Patients in the most deprived WIMD quintile had an overall prescription rate that was 25.2% higher than those in the least deprived WIMD quintile. The final model revealed that residing in the most deprived WIMD quintile (incidence rate ratio [IRR] = 1.1769, 95% confidence interval [CI] 1.1768 to 1.1770, being female (IRR = 1,2699, 95% CI 1.2698 to 1.2700), being aged $\geq$90 (IRR = 2.0687, 95% CI 2.0683 to 2.0690), and prescription year being 2013 were associated with significantly higher rate of antibiotics prescription. There were significant primary cares clustering of antibiotics prescription in Wales. Conclusion/ImplicationsThis study provides evidence that patients in areas of higher socioeconomic deprivation are more likely to be prescribed antibiotics in primary care in Wales. Population health prevention strategies aimed at reducing high antibiotic prescription rates should consider targeting areas of high deprivation.

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