The impact of a national antimicrobial stewardship programme on antibiotic prescribing in primary care: an interrupted time series analysis
File(s)Manuscript.docx (41.84 KB)
Accepted version
Author(s)
Balinskaite, Violeta
Johnson, Alan P
Holmes, Alison
Aylin, Paul
Type
Journal Article
Abstract
Background: The Quality Premium was introduced in 2015 to financially reward local commissioners of healthcare in England for targeted reductions in antibiotic prescribing in primary care. Methods: We used a national antibiotic prescribing dataset from April 2013 till February 2017 to examine the number of antibiotic items prescribed, the total number of antibiotic items prescribed per STAR-PU (Specific Therapeutic Group Age-sex Related Prescribing Units), the number of broad-spectrum antibiotic items prescribed and broad-spectrum antibiotic items prescribed expressed as a percentage of the total number of antibiotic items. To evaluate the impact of the Quality Premium on antibiotic prescribing, we used a segmented regression analysis of interrupted time series data. Results: During the study period, over 140 million antibiotic items were prescribed in primary care. Following the introduction of the Quality Premium, antibiotic items prescribed decreased by 8.2%, representing 5,933,563 fewer antibiotic items prescribed during the 23 post-intervention months compared with the expected numbers based on the trend in the pre-intervention period. After adjusting for the age and sex distribution in the population, the segmented regression model also showed a significant relative decrease in antibiotic items prescribed per STAR-PU. A similar effect was found for broad-spectrum antibiotics (comprising 10.1% of total antibiotic prescribing), with an 18.9% reduction in prescribing. Conclusions: This study shows that the introduction of financial incentives for local commissioners of healthcare to improve the quality of prescribing was associated with a significant reduction in both total and broad-spectrum antibiotic prescribing in primary care in England.
Date Issued
2019-07-15
Date Acceptance
2018-10-15
Citation
Clinical Infectious Diseases, 2019, 69 (2), pp.227-232
ISSN
1058-4838
Publisher
Oxford University Press (OUP)
Start Page
227
End Page
232
Journal / Book Title
Clinical Infectious Diseases
Volume
69
Issue
2
Copyright Statement
© The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com. This is a pre-copy-editing, author-produced version of an article accepted for publication in Clinical Infectious Diseases following peer review. The definitive publisher-authenticated version is available online at: https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciy902/5136399
Sponsor
DOH Policy Research Programme
National Institute for Health Research
Dr Foster Intelligence
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/30339190
PII: 5136399
Grant Number
n/a
WPPA_P72388
Subjects
antibiotic prescribing
antimicrobial stewardship programs
interrupted time series
Microbiology
06 Biological Sciences
11 Medical and Health Sciences
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2018-10-18