Antibiotic prescribing for upper respiratory tract infections and acute bronchitis: a longitudinal analysis of general practitioner trainees.

Humans General Practitioners Inappropriate Prescribing Anti-Bacterial Agents / therapeutic use Practice Patterns, Physicians' Australia Respiratory Tract Infections / drug therapy Bronchitis / drug therapy Acute Disease Bronchiolitis / drug therapy
antibacterial agents antimicrobial stewardship general practitioners graduate medical education inappropriate prescribing respiratory tract infections

Journal

Family practice
ISSN: 1460-2229
Titre abrégé: Fam Pract
Pays: England
ID NLM: 8500875

Informations de publication

Date de publication:
22 11 2022
Historique:
pubmed: 1 6 2022
medline: 25 11 2022
entrez: 31 5 2022
Statut: ppublish

Résumé

Most antibiotic prescribing for upper respiratory tract infections (URTIs) and acute bronchitis is inappropriate. Substantive and sustained reductions in prescribing are needed to reduce antibiotic resistance. Prescribing habits develop early in clinicians' careers. Hence, general practice (GP) trainees are an important group to target. We aimed to establish temporal trends in antibiotic prescribing for URTIs and acute bronchitis/bronchiolitis by Australian GP trainees (registrars). A longitudinal analysis, 2010-2019, of the Registrars Clinical Encounters in Training (ReCEnT) dataset. In ReCEnT, registrars record clinical and educational content of 60 consecutive consultations, on 3 occasions, 6 monthly. Analyses were of new diagnoses of URTI and acute bronchitis/bronchiolitis, with the outcome variable a systemic antibiotic being prescribed. The independent variable of interest was year of prescribing (modelled as a continuous variable). 28,372 diagnoses of URTI and 5,289 diagnoses of acute bronchitis/bronchiolitis were recorded by 2,839 registrars. Antibiotic prescribing for URTI decreased from 24% in 2010 to 12% in 2019. Prescribing for acute bronchitis/bronchiolitis decreased from 84% to 72%. "Year" was significantly, negatively associated with antibiotic prescribing for both URTI (odds ratio [OR] 0.90; 95% confidence interval [CI]: 0.88-0.93) and acute bronchitis/bronchiolitis (OR 0.92; 95% CI: 0.88-0.96) on multivariable analysis, with estimates representing the mean annual change. GP registrars' prescribing for URTI and acute bronchitis/bronchiolitis declined over the 10-year period. Prescribing for acute bronchitis/bronchiolitis, however, remains higher than recommended benchmarks. Continued education and programme-level antibiotic stewardship interventions are required to further reduce registrars' antibiotic prescribing for acute bronchitis/bronchiolitis to appropriate levels. It is well known that antibiotic consumption can cause antibiotic resistance. Most antibiotic prescribing happens in general practice. The common cold (upper respiratory tract infections) and cough (acute bronchitis) are 2 conditions that antibiotics are often prescribed for, but are not needed. There is considerable evidence that antibiotics do not help these conditions improve, and guidelines in Australia state that they are not a treatment option. General practitioners at the beginning of their career form prescribing habits early on. In light of the problem of antibiotic resistance, it is important to know how new doctors prescribe antibiotics, as they may do this for the rest of their career. We investigated their prescribing for the common cold and cough, from 2010 to 2019. We found that overall their prescribing has been declining over the last 10 years, but prescribing for cough is still too high. There needs to be more interventions in this group of doctors to reduce prescribing for this condition.

Sections du résumé

BACKGROUND
Most antibiotic prescribing for upper respiratory tract infections (URTIs) and acute bronchitis is inappropriate. Substantive and sustained reductions in prescribing are needed to reduce antibiotic resistance. Prescribing habits develop early in clinicians' careers. Hence, general practice (GP) trainees are an important group to target.
OBJECTIVES
We aimed to establish temporal trends in antibiotic prescribing for URTIs and acute bronchitis/bronchiolitis by Australian GP trainees (registrars).
METHODS
A longitudinal analysis, 2010-2019, of the Registrars Clinical Encounters in Training (ReCEnT) dataset. In ReCEnT, registrars record clinical and educational content of 60 consecutive consultations, on 3 occasions, 6 monthly. Analyses were of new diagnoses of URTI and acute bronchitis/bronchiolitis, with the outcome variable a systemic antibiotic being prescribed. The independent variable of interest was year of prescribing (modelled as a continuous variable).
RESULTS
28,372 diagnoses of URTI and 5,289 diagnoses of acute bronchitis/bronchiolitis were recorded by 2,839 registrars. Antibiotic prescribing for URTI decreased from 24% in 2010 to 12% in 2019. Prescribing for acute bronchitis/bronchiolitis decreased from 84% to 72%. "Year" was significantly, negatively associated with antibiotic prescribing for both URTI (odds ratio [OR] 0.90; 95% confidence interval [CI]: 0.88-0.93) and acute bronchitis/bronchiolitis (OR 0.92; 95% CI: 0.88-0.96) on multivariable analysis, with estimates representing the mean annual change.
CONCLUSIONS
GP registrars' prescribing for URTI and acute bronchitis/bronchiolitis declined over the 10-year period. Prescribing for acute bronchitis/bronchiolitis, however, remains higher than recommended benchmarks. Continued education and programme-level antibiotic stewardship interventions are required to further reduce registrars' antibiotic prescribing for acute bronchitis/bronchiolitis to appropriate levels.
It is well known that antibiotic consumption can cause antibiotic resistance. Most antibiotic prescribing happens in general practice. The common cold (upper respiratory tract infections) and cough (acute bronchitis) are 2 conditions that antibiotics are often prescribed for, but are not needed. There is considerable evidence that antibiotics do not help these conditions improve, and guidelines in Australia state that they are not a treatment option. General practitioners at the beginning of their career form prescribing habits early on. In light of the problem of antibiotic resistance, it is important to know how new doctors prescribe antibiotics, as they may do this for the rest of their career. We investigated their prescribing for the common cold and cough, from 2010 to 2019. We found that overall their prescribing has been declining over the last 10 years, but prescribing for cough is still too high. There needs to be more interventions in this group of doctors to reduce prescribing for this condition.

Autres résumés

Type: plain-language-summary (eng)
It is well known that antibiotic consumption can cause antibiotic resistance. Most antibiotic prescribing happens in general practice. The common cold (upper respiratory tract infections) and cough (acute bronchitis) are 2 conditions that antibiotics are often prescribed for, but are not needed. There is considerable evidence that antibiotics do not help these conditions improve, and guidelines in Australia state that they are not a treatment option. General practitioners at the beginning of their career form prescribing habits early on. In light of the problem of antibiotic resistance, it is important to know how new doctors prescribe antibiotics, as they may do this for the rest of their career. We investigated their prescribing for the common cold and cough, from 2010 to 2019. We found that overall their prescribing has been declining over the last 10 years, but prescribing for cough is still too high. There needs to be more interventions in this group of doctors to reduce prescribing for this condition.

Identifiants

DOI: 10.1093/fampra/cmac052 PMID: 35640041 PMC: PMC9680663
pubmed: 35640041
pii: 6594428
doi: 10.1093/fampra/cmac052
pmc: PMC9680663
doi:

Substances chimiques

Anti-Bacterial Agents 0

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

1063-1069

Informations de copyright

© The Author(s) 2022. Published by Oxford University Press.

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Auteurs

Emma J Baillie (EJ)

General Practice Clinical Unit, The University of Queensland, Brisbane, QLD 4006, Australia.

Gregory Merlo (G)

General Practice Clinical Unit, The University of Queensland, Brisbane, QLD 4006, Australia.
ORCID: 0000-0001-9931-7830

Parker Magin (P)

School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
GP Synergy NSW & ACT Research and Evaluation Unit, Newcastle, NSW, Australia.
ORCID: 0000-0001-8071-8749

Amanda Tapley (A)

School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
GP Synergy NSW & ACT Research and Evaluation Unit, Newcastle, NSW, Australia.
ORCID: 0000-0002-1536-5518

Katie J Mulquiney (KJ)

School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
GP Synergy NSW & ACT Research and Evaluation Unit, Newcastle, NSW, Australia.
ORCID: 0000-0002-2380-4787

Joshua S Davis (JS)

School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
ORCID: 0000-0001-9864-5699

Alison Fielding (A)

School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
GP Synergy NSW & ACT Research and Evaluation Unit, Newcastle, NSW, Australia.
ORCID: 0000-0001-5884-3068

Andrew Davey (A)

School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
GP Synergy NSW & ACT Research and Evaluation Unit, Newcastle, NSW, Australia.
ORCID: 0000-0002-7547-779X

Elizabeth Holliday (E)

School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
ORCID: 0000-0002-4066-6224

Jean Ball (J)

Hunter Medical Research Institute, Clinical Research Design and Statistical Support Unit (CReDITSS), New Lambton Heights, NSW 2305, Australia.
ORCID: 0000-0001-5402-6415

Neil Spike (N)

Eastern Victoria General Practice Training, Regional Training Organisation, Hawthorn, VIC 3122, Australia.
University of Melbourne, Department of General Practice and Primary Health Care, Berkeley Street, Carlton, VIC 3053, Australia.
Monash University, School of Rural Health, Wellington Road, Clayton, VIC 3800, Australia.
ORCID: 0000-0002-9694-8642

Kristen FitzGerald (K)

University of Tasmania, Tasmanian School of Medicine, Hobart, TAS 7000, Australia.
General Practice Training Tasmania, Regional Training Organisation, Hobart, TAS 7000, Australia.
ORCID: 0000-0002-7280-2278

Mieke L van Driel (ML)

General Practice Clinical Unit, The University of Queensland, Brisbane, QLD 4006, Australia.
ORCID: 0000-0003-1711-9553

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Antibiotic prescribing for upper respiratory...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Personnel de santé › Médecins › Médecins généralistes › Antibiotic prescribing for upper respiratory...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Erreurs médicales › Erreurs de médication › Prescription inappropriée › Antibiotic prescribing for upper respiratory...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Anti-infectieux › Antibactériens › Antibiotic prescribing for upper respiratory...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Prestations des soins de santé › Types de pratiques des médecins › Antibiotic prescribing for upper respiratory...
questionsmedicales.fr › Régions géographiques › Océanie › Australasie › Australie › Antibiotic prescribing for upper respiratory...
questionsmedicales.fr › Maladies de l'appareil respiratoire › Infections de l'appareil respiratoire › Antibiotic prescribing for upper respiratory...
questionsmedicales.fr › Maladies de l'appareil respiratoire › Infections de l'appareil respiratoire › Bronchite › Antibiotic prescribing for upper respiratory...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Caractéristiques de la maladie › Maladie aigüe › Antibiotic prescribing for upper respiratory...
questionsmedicales.fr › Maladies de l'appareil respiratoire › Infections de l'appareil respiratoire › Bronchite › Bronchiolite › Antibiotic prescribing for upper respiratory...