Age-related decline in antibiotic prescribing for uncomplicated respiratory tract infections in primary care in England following the introduction of a national financial incentive (the Quality Premium) for health commissioners to reduce use of antibiotics in the community: an interrupted time series analysis

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Title: Age-related decline in antibiotic prescribing for uncomplicated respiratory tract infections in primary care in England following the introduction of a national financial incentive (the Quality Premium) for health commissioners to reduce use of antibiotics in the community: an interrupted time series analysis
Authors: Aylin, PP
Bou-Antoun, S
Costelloe, CE
Honeyford, CE
Hayhoe, B
Holmes, A
Mazidi, M
Johnson, AP
Item Type: Journal Article
Abstract: Objectives: To assess the impact of the 2015/16 NHS England Quality Premium (which provided a financial incentive for Clinical Commissioning Groups to reduce antibiotic prescribing in primary care) on antibiotic prescribing by General Practitioners (GPs) for respiratory tract infections (RTIs). Method: Interrupted time series analysis using monthly patient-level consultation and prescribing data obtained from the Clinical Practice Research Datalink (CPRD), between April 2011 and March 2017. The study population comprised patients consulting a GP who were diagnosed with an RTI. We assessed the rate of antibiotic prescribing in patients (both aggregate and stratified by age) with a recorded diagnosis of uncomplicated RTI, before and after the implementation of the Quality Premium. Results: Prescribing rates decreased over the six year study period, with evident seasonality. Notably, there was a 3% drop in the rate of antibiotic prescribing (equating to 14.65 prescriptions per 1,000 RTI consultations) (p<0.05) in April 2015, coinciding with the introduction of the Quality Premium. This reduction was sustained, such that after two years there was a 3% decrease in prescribing relative to that expected had the pre-intervention trend continued. There was also a concurrent 2% relative reduction in the rate of broad-spectrum antibiotic prescribing. Antibiotic prescribing for RTIs diagnosed in children showed the greatest decline with a 6% relative change two years after the intervention. Of the RTI indications studied, the greatest reductions in antibiotic prescribing were seen for patients with sore throats. Conclusions: Community prescribing of antibiotics for RTIs significantly decreased following the introduction of the Quality Premium, with the greatest reduction seen in younger patients.
Issue Date: Oct-2018
Date of Acceptance: 22-May-2018
URI: http://hdl.handle.net/10044/1/60358
DOI: https://doi.org/10.1093/jac/dky237
ISSN: 0305-7453
Publisher: Oxford University Press
Start Page: 2883
End Page: 2892
Journal / Book Title: Journal of Antimicrobial Chemotherapy
Volume: 73
Issue: 10
Copyright Statement: © The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.
Sponsor/Funder: National Institute for Health Research
National Institute for Health Research
Dr Foster Intelligence
National Institute for Health Research
Funder's Grant Number: HPRU-2012-10047
HPRU-2012-10047
N/A
n/a
Keywords: Science & Technology
Life Sciences & Biomedicine
Infectious Diseases
Microbiology
Pharmacology & Pharmacy
CONSULTATIONS
RESISTANCE
REGRESSION
Microbiology
1115 Pharmacology and Pharmaceutical Sciences
0605 Microbiology
1108 Medical Microbiology
Publication Status: Published
Article Number: dky237
Online Publication Date: 2018-06-28
Appears in Collections:Faculty of Medicine
Epidemiology, Public Health and Primary Care



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