scholarly journals Public preferences for delayed or immediate antibiotic prescriptions in UK primary care: A choice experiment

PLoS Medicine ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. e1003737
Author(s):  
Liz Morrell ◽  
James Buchanan ◽  
Laurence S. J. Roope ◽  
Koen B. Pouwels ◽  
Christopher C. Butler ◽  
...  
Keyword(s):  
Primary Care ◽  
Sore Throat ◽  
Choice Experiment ◽  
Real Life ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Patient Acceptance ◽  
Adult Sample ◽  
Duration Of Illness ◽  
The Uk

Background Delayed (or “backup”) antibiotic prescription, where the patient is given a prescription but advised to delay initiating antibiotics, has been shown to be effective in reducing antibiotic use in primary care. However, this strategy is not widely used in the United Kingdom. This study aimed to identify factors influencing preferences among the UK public for delayed prescription, and understand their relative importance, to help increase appropriate use of this prescribing option. Methods and findings We conducted an online choice experiment in 2 UK general population samples: adults and parents of children under 18 years. Respondents were presented with 12 scenarios in which they, or their child, might need antibiotics for a respiratory tract infection (RTI) and asked to choose either an immediate or a delayed prescription. Scenarios were described by 7 attributes. Data were collected between November 2018 and February 2019. Respondent preferences were modelled using mixed-effects logistic regression. The survey was completed by 802 adults and 801 parents (75% of those who opened the survey). The samples reflected the UK population in age, sex, ethnicity, and country of residence. The most important determinant of respondent choice was symptom severity, especially for cough-related symptoms. In the adult sample, the probability of choosing delayed prescription was 0.53 (95% confidence interval (CI) 0.50 to 0.56, p < 0.001) for a chesty cough and runny nose compared to 0.30 (0.28 to 0.33, p < 0.001) for a chesty cough with fever, 0.47 (0.44 to 0.50, p < 0.001) for sore throat with swollen glands, and 0.37 (0.34 to 0.39, p < 0.001) for sore throat, swollen glands, and fever. Respondents were less likely to choose delayed prescription with increasing duration of illness (odds ratio (OR) 0.94 (0.92 to 0.96, p < 0.001)). Probabilities of choosing delayed prescription were similar for parents considering treatment for a child (44% of choices versus 42% for adults, p = 0.04). However, parents differed from the adult sample in showing a more marked reduction in choice of the delayed prescription with increasing duration of illness (OR 0.83 (0.80 to 0.87) versus 0.94 (0.92 to 0.96) for adults, p for heterogeneity p < 0.001) and a smaller effect of disruption of usual activities (OR 0.96 (0.95 to 0.97) versus 0.93 (0.92 to 0.94) for adults, p for heterogeneity p < 0.001). Females were more likely to choose a delayed prescription than males for minor symptoms, particularly minor cough (probability 0.62 (0.58 to 0.66, p < 0.001) for females and 0.45 (0.41 to 0.48, p < 0.001) for males). Older people, those with a good understanding of antibiotics, and those who had not used antibiotics recently showed similar patterns of preferences. Study limitations include its hypothetical nature, which may not reflect real-life behaviour; the absence of a “no prescription” option; and the possibility that study respondents may not represent the views of population groups who are typically underrepresented in online surveys. Conclusions This study found that delayed prescription appears to be an acceptable approach to reducing antibiotic consumption. Certain groups appear to be more amenable to delayed prescription, suggesting particular opportunities for increased use of this strategy. Prescribing choices for sore throat may need additional explanation to ensure patient acceptance, and parents in particular may benefit from reassurance about the usual duration of these illnesses.

scholarly journals Delayed Antibiotic Prescription by General Practitioners in the UK: A Stated-Choice Study

Antibiotics ◽  
2020 ◽  
Vol 9 (9) ◽  
pp. 608
Author(s):  
Liz Morrell ◽  
James Buchanan ◽  
Laurence Roope ◽  
Koen Pouwels ◽  
Christopher Butler ◽  
...  
Keyword(s):  
General Practitioners ◽  
Antibiotic Prescription ◽  
Antibiotic Consumption ◽  
Patient Acceptance ◽  
Stated Choice ◽  
Factors Affecting ◽  
Duration Of Illness ◽  
Increasing Risk ◽  
The Uk ◽  
Delayed Antibiotic Prescription

Delayed antibiotic prescription in primary care has been shown to reduce antibiotic consumption, without increasing risk of complications, yet is not widely used in the UK. We sought to quantify the relative importance of factors affecting the decision to give a delayed prescription, using a stated-choice survey among UK general practitioners. Respondents were asked whether they would provide a delayed or immediate prescription in fifteen hypothetical consultations, described by eight attributes. They were also asked if they would prefer not to prescribe antibiotics. The most important determinants of choice between immediate and delayed prescription were symptoms, duration of illness, and the presence of multiple comorbidities. Respondents were more likely to choose a delayed prescription if the patient preferred not to have antibiotics, but consultation length had little effect. When given the option, respondents chose not to prescribe antibiotics in 51% of cases, with delayed prescription chosen in 21%. Clinical features remained important. Patient preference did not affect the decision to give no antibiotics. We suggest that broader dissemination of the clinical evidence supporting use of delayed prescription for specific presentations may help increase appropriate use. Establishing patient preferences regarding antibiotics may help to overcome concerns about patient acceptance. Increasing consultation length appears unlikely to affect the use of delayed prescription.

scholarly journals From Point-of-Care Testing (PoCT) and vaccination to changing the care paradigm: the role of primary care

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
E Petelos ◽  
C Lionis
Keyword(s):  
Primary Care ◽  
Cancer Patients ◽  
Point Of Care ◽  
Behavioural Change ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Prescribing Patterns ◽  
Patient Treatment ◽  
Therapeutic Decisions

Abstract The speaker will discuss the role of primary care for all patients and cancer patients, elaborating on prescribing patterns vaccinations, recommendations for Over-The-Counter medicines (OTCs) nutritional supplements, and as well as its contribution of behavioural change to raise awareness and change prescription practice. The role of PoCT for reducing the threat of AMR and for improving the differential diagnosis will be discussed, according to the WHO Approach of “diagnostic stewardship” for the appropriate use of microbiological diagnostics to guide therapeutic decisions. In the context of syndromic surveillance and preparedness, as well as in terms of protecting cancer patients at times of epidemics, methods of specimen collection for limited community transmission and for the timely pathogen identification along with accurate, timely reporting of results to guide patient treatment will be discussed. The role of behavioural modification interventions will be discussed, incl. in relation to vaccination and the role it can play in AMR. Improvement of the survivorship experience will be examined in the context of improving health literacy. The case of Greece, currently having the highest antibiotic consumption in Europe and the fourth highest globally, along with an increasing trend on antibiotic use will also be discussed.

scholarly journals PRImary care Streptococcal Management (PRISM) study: in vitro study, diagnostic cohorts and a pragmatic adaptive randomised controlled trial with nested qualitative study and cost-effectiveness study

2014 ◽  
Vol 18 (6) ◽  
pp. 1-102 ◽  
Author(s):  
Paul Little ◽  
FD Richard Hobbs ◽  
Michael Moore ◽  
David Mant ◽  
Ian Williamson ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Sore Throat ◽  
Controlled Trial ◽  
In Vitro Study ◽  
Clinical Score ◽  
Antibiotic Use ◽  
Clinical Scores ◽  
Randomised Controlled

BackgroundAntibiotics are still prescribed to most patients attending primary care with acute sore throat, despite evidence that there is modest benefit overall from antibiotics. Targeting antibiotics using either clinical scoring methods or rapid antigen detection tests (RADTs) could help. However, there is debate about which groups of streptococci are important (particularly Lancefield groups C and G), and uncertainty about the variables that most clearly predict the presence of streptococci.ObjectiveThis study aimed to compare clinical scores or RADTs with delayed antibiotic prescribing.DesignThe study comprised a RADT in vitro study; two diagnostic cohorts to develop streptococcal scores (score 1; score 2); and, finally, an open pragmatic randomised controlled trial with nested qualitative and cost-effectiveness studies.SettingThe setting was UK primary care general practices.ParticipantsParticipants were patients aged ≥ 3 years with acute sore throat.InterventionsAn internet program randomised patients to targeted antibiotic use according to (1) delayed antibiotics (control group), (2) clinical score or (3) RADT used according to clinical score.Main outcome measuresThe main outcome measures were self-reported antibiotic use and symptom duration and severity on seven-point Likert scales (primary outcome: mean sore throat/difficulty swallowing score in the first 2–4 days).ResultsThe IMI TestPack Plus Strep A (Inverness Medical, Bedford, UK) was sensitive, specific and easy to use. Lancefield group A/C/G streptococci were found in 40% of cohort 2 and 34% of cohort 1. A five-point score predicting the presence of A/C/G streptococci [FeverPAIN: Fever; Purulence; Attend rapidly (≤ 3 days); severe Inflammation; and No cough or coryza] had moderate predictive value (bootstrapped estimates of area under receiver operating characteristic curve: 0.73 cohort 1, 0.71 cohort 2) and identified a substantial number of participants at low risk of streptococcal infection. In total, 38% of cohort 1 and 36% of cohort 2 scored ≤ 1 for FeverPAIN, associated with streptococcal percentages of 13% and 18%, respectively. In an adaptive trial design, the preliminary score (score 1;n = 1129) was replaced by FeverPAIN (n = 631). For score 1, there were no significant differences between groups. For FeverPAIN, symptom severity was documented in 80% of patients, and was lower in the clinical score group than in the delayed prescribing group (–0.33; 95% confidence interval –0.64 to –0.02;p = 0.039; equivalent to one in three rating sore throat a slight rather than moderately bad problem), and a similar reduction was observed for the RADT group (–0.30; –0.61 to 0.00;p = 0.053). Moderately bad or worse symptoms resolved significantly faster (30%) in the clinical score group (hazard ratio 1.30; 1.03 to 1.63) but not the RADT group (1.11; 0.88 to 1.40). In the delayed group, 75/164 (46%) used antibiotics, and 29% fewer used antibiotics in the clinical score group (risk ratio 0.71; 0.50 to 0.95;p = 0.018) and 27% fewer in the RADT group (0.73; 0.52 to 0.98;p = 0.033). No significant differences in complications or reconsultations were found. The clinical score group dominated both other groups for both the cost/quality-adjusted life-years and cost/change in symptom severity analyses, being both less costly and more effective, and cost-effectiveness acceptability curves indicated the clinical score to be the most likely to be cost-effective from an NHS perspective. Patients were positive about RADTs. Health professionals’ concerns about test validity, the time the test took and medicalising self-limiting illness lessened after using the tests. For both RADTs and clinical scores, there were tensions with established clinical experience.ConclusionsTargeting antibiotics using a clinical score (FeverPAIN) efficiently improves symptoms and reduces antibiotic use. RADTs used in combination with FeverPAIN provide no clear advantages over FeverPAIN alone, and RADTs are unlikely to be incorporated into practice until health professionals’ concerns are met and they have experience of using them. Clinical scores also face barriers related to clinicians’ perceptions of their utility in the face of experience. This study has demonstrated the limitation of using one data set to develop a clinical score. FeverPAIN, derived from two data sets, appears to be valid and its use improves outcomes, but diagnostic studies to confirm the validity of FeverPAIN in other data sets and settings are needed. Experienced clinicians need to identify barriers to the use of clinical scoring methods. Implementation studies that address perceived barriers in the use of FeverPAIN are needed.Trial registrationCurrent Controlled Trials ISRCTN32027234.Source of fundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 18, No. 6. See the NIHR Journals Library website for further project information.

scholarly journals Outpatient Antibiotic Consumption Fluctuations in a View of Unreasonable Antibacterial Therapy

2017 ◽  
Vol 66 (1) ◽  
pp. 119-123 ◽  
Author(s):  
Marcin Ciszewski ◽  
Tomasz Czekaj ◽  
Eligia M. Szewczyk
Keyword(s):  
Primary Care ◽  
Viral Infection ◽  
Central Europe ◽  
Antibacterial Therapy ◽  
Seasonal Variability ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Resistant Bacteria ◽  
Primary Care System ◽  
Consumption Fluctuations

Unreasonable antibacterial therapy is suspected to be the main reason of emergence of multi-resistant bacteria. The connection between seasonal variability of antibiotic use and reasonable antibacterial therapy has been described. We examined the issue basing on the data obtained from the primary care system in Szczecin (Poland) in order to verify the situation in this region of Central Europe. Increase in antibiotic consumption in a viral infection season was proved to be statistically significant. Statistically significant differences in various drug forms dispensation were also observed. Increased consumption of antibiotics in seasons of influenza-like illnesses might be connected with a lack of proper diagnostics or numerous cases of bacterial co-infections.

Tonsillitis

2017 ◽  
Vol 10 (10) ◽  
pp. 577-584 ◽  
Author(s):  
Hussein Walijee ◽  
Chirag Patel ◽  
Pranter Brahmabhatt ◽  
Madhankumar Krishnan
Keyword(s):  
Primary Care ◽  
Young Adults ◽  
Sore Throat ◽  
Antimicrobial Stewardship ◽  
Economic Burden ◽  
Acute Tonsillitis ◽  
The Uk

Tonsillitis is a condition that is commonly encountered in primary care. On average 50 per 1000 patients consult their GP each year with a sore throat. Tonsillitis is a significant economic burden, with 35 000 000 days lost from work or school. Acute tonsillitis commonly affects children from the age of 4 years (highly prevalent between 4 and 8 years old) and young adults aged between 15 and 25 years old. With the emergence of multi-resistant pathogens, antimicrobial stewardship has become central to the strategies adopted by the National Institute for Health and Care Excellence in the UK.

scholarly journals Effects of restrictive-prescribing stewardship on antibiotic consumption in primary care in China: an interrupted time series analysis, 2012–2017

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Xuemei Wang ◽  
Yuqing Tang ◽  
Chenxi Liu ◽  
Junjie Liu ◽  
Youwen Cui ◽  
...  
Keyword(s):  
Primary Care ◽  
Time Series ◽  
Time Series Analysis ◽  
Interrupted Time Series ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Downward Trend ◽  
Fourth Generation ◽  
Interrupted Time Series Analysis ◽  
Trend Coefficient

Abstract Background The overuse of antibiotics has been a major public health problem worldwide, especially in low- and middle- income countries (LMIC). However, there are few policies specific to antibiotic stewardship in primary care and their effectiveness are still unclear. A restrictive-prescribing stewardship targeting antibiotic use in primary care has been implemented since December 2014 in Hubei Province, China. This study aimed to evaluate the effects of the restrictive-prescribing stewardship on antibiotic consumption in primary care so as to provide evidence-based suggestions for prudent use of antibiotics. Methods Monthly antibiotic consumption data were extracted from Hubei Medical Procurement Administrative Agency (HMPA) system from Sept 1, 2012, to Aug 31, 2017. Quality Indictors of European Surveillance of Antimicrobial Consumption (ESAC QIs) combined with Anatomical Therapeutic Chemical (ATC) classification codes and DDD per 1000 inhabitants per day (DID) methodology were applied to measure antibiotic consumption. An interrupted time series analysis was performed to evaluate the effects of restrictive-prescribing stewardship on antibiotic consumption. Results Over the entire study period, a significant reduction (32.58% decrease) was observed in total antibiotic consumption, which declined immediately after intervention (coefficient = − 2.4518, P = 0.005) and showed a downward trend (coefficient = − 0.1193, P = 0.017). Specifically, the use of penicillins, cephalosporins and macrolides/lincosamides/streptogramins showed declined trends after intervention (coefficient = − 0.0553, P = 0.035; coefficient = − 0.0294, P = 0.037; coefficient = − 0.0182, P = 0.003, respectively). An immediate decline was also found in the contribution of β-lactamase-sensitive penicillins to total antibiotic use (coefficient = − 2.9126, P = 0.001). However, an immediate increase in the contribution of third and fourth-generation cephalosporins (coefficient = 5.0352, P = 0.005) and an ascending trend in the contribution of fluoroquinolones (coefficient = 0.0406, P = 0.037) were observed after intervention. The stewardship led to an immediate increase in the ratio between broad- and narrow-spectrum antibiotic use (coefficient = 1.8747, P = 0.001) though they both had a significant downward trend (coefficient = − 0.0423, P = 0.017; coefficient = − 0.0223, P = 0.006, respectively). An immediate decline (coefficient = − 1.9292, P = 0.002) and a downward trend (coefficient = − 0.0815, P = 0.018) were also found in the oral antibiotic use after intervention, but no significant changes were observed in the parenteral antibiotic use. Conclusions Restrictive-prescribing stewardship in primary care was effective in reducing total antibiotic consumption, especially the use of penicillins, cephalosporins and macrolides/lincosamides/streptogramins. However, the intervention effects were limited regarding the use of combinations of penicillins with ß-lactamase inhibitors, the third and fourth-generation cephalosporins, fluoroquinolones and parenteral antibiotics. Stronger administrative regulations focusing on specific targeted antibiotics, especially the use of broad-spectrum antibiotics and parenteral antibiotics, are in urgent need in the future.

scholarly journals Diversity in the emergency care for febrile children in Europe: a questionnaire study

2019 ◽  
Vol 3 (1) ◽  
pp. e000456 ◽  
Author(s):  
Dorine Borensztajn ◽  
Shunmay Yeung ◽  
Nienke N Hagedoorn ◽  
Anda Balode ◽  
Ulrich von Both ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Physician ◽  
Point Of Care ◽  
Real Life ◽  
Febrile Illness ◽  
Diagnostic Tools ◽  
Admission Rates ◽  
Paediatric Emergency ◽  
General Paediatrician ◽  
The Uk

ObjectiveTo provide an overview of care in emergency departments (EDs) across Europe in order to interpret observational data and implement interventions regarding the management of febrile children.Design and settingAn electronic questionnaire was sent to the principal investigators of an ongoing study (PERFORM (Personalised Risk assessment in Febrile illness to Optimise Real-life Management), www.perform2020.eu) in 11 European hospitals in eight countries: Austria, Germany, Greece, Latvia, the Netherlands, Slovenia, Spain and the UK.Outcome measuresThe questionnaire covered indicators in three domains: local ED quality (supervision, guideline availability, paper vs electronic health records), organisation of healthcare (primary care, immunisation), and local factors influencing or reflecting resource use (availability of point-of-care tests, admission rates).ResultsReported admission rates ranged from 4% to 51%. In six settings (Athens, Graz, Ljubljana, Riga, Rotterdam, Santiago de Compostela), the supervising ED physicians were general paediatricians, in two (Liverpool, London) these were paediatric emergency physicians, in two (Nijmegen, Newcastle) supervision could take place by either a general paediatrician or a general emergency physician, and in one (München) this could be either a general paediatrician or a paediatric emergency physician. The supervising physician was present on site in all settings during office hours and in five out of eleven settings during out-of-office hours. Guidelines for fever and sepsis were available in all settings; however, the type of guideline that was used differed. Primary care was available in all settings during office hours and in eight during out-of-office hours. There were differences in routine immunisations as well as in additional immunisations that were offered; immunisation rates varied between and within countries.ConclusionDifferences in local, regional and national aspects of care exist in the management of febrile children across Europe. This variability has to be considered when trying to interpret differences in the use of diagnostic tools, antibiotics and admission rates. Any future implementation of interventions or diagnostic tests will need to be aware of this European diversity.

scholarly journals Management of COPD in the UK primary-care setting: an analysis of real-life prescribing patterns

2014 ◽  
pp. 889 ◽  
Author(s):  
David Price ◽  
Daniel West ◽  
Guy Brusselle ◽  
Kevin Gruffydd-Jones ◽  
Rupert Jones ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Real Life ◽  
Prescribing Patterns ◽  
The Uk

scholarly journals Consumption of Antibacterials for Systemic Use in Slovakia: A National Study and the Quality Indicators for Outpatient Antibiotic Use

Antibiotics ◽  
2021 ◽  
Vol 10 (10) ◽  
pp. 1180
Author(s):  
Tomas Tesar ◽  
Lucia Masarykova ◽  
Lubica Lehocka ◽  
Slavka Porubcova ◽  
Monika Cicova ◽  
...  
Keyword(s):  
Primary Care ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Fourth Generation ◽  
National Study ◽  
Beta Lactamase ◽  
Total Consumption ◽  
Primary Care Sector ◽  
Data Source ◽  
Lactamase Inhibitor

This paper aims to analyse the consumption of antibiotics in the Slovak health care system from 2011 to 2020. The data source on the consumption of antibiotics is sales data from SUKL and NCZI. The study employed the ATC/DDD Index and focused on the consumption of antibiotics in the primary care sector. Total antibiotic consumption decreased from 19.21 DID in 2011 to 13.16 DID in 2020. Consumption of beta-lactamase-sensitive penicillins, expressed as a percentage of the total consumption of antibiotics, decreased from 8.4% in 2011 to 4.2% in 2020. Consumption of the combination of penicillins, including beta-lactamase inhibitor, expressed as a percentage of the total consumption of antibiotics, increased from 16.2% in 2011 to 17.9% in 2020. Consumption of third- and fourth-generation cephalosporins, expressed as the percentage of the total consumption of antibiotics, increased from 2.0% in 2011 to 4.6% in 2020. Consumption of fluoroquinolones, expressed as the percentage of the total consumption of antibiotics, decreased from 10.7% in 2011 to 8.6% in 2020. Overall, antibiotic consumption significantly changed in Slovakia from 2011 to 2020. The ratio of the consumption of broad-spectrum to the consumption of narrow-spectrum penicillins, cephalosporins and macrolides decreased from 14.98 in 2011 to 13.38 in 2020.

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