Changes in early-career family physicians' antibiotic prescribing for upper respiratory tract infection and acute bronchitis

A multicentre longitudinal study

Parker J. Magin, Simon Morgan, Amanda Tapley, Kim M. Henderson, Elizabeth G. Holliday, Jean Ball, Joshua S. Davis, Anthea Dallas, Andrew R. Davey, Neil A. Spike, Lawrie McArthur, Rebecca Stewart, Katie J. Mulquiney, Mieke L. van Driel

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Inappropriate antibiotic prescription and subsequent antibacterial resistance are major threats to health worldwide. 

Objectives: We aimed to establish whether early-career 'apprenticeship-model' experience in family practice influences antibiotic prescribing for respiratory tract infections and to also establish other associations of antibiotic prescribing changes during this early-career experience. 

Methods: A longitudinal analysis (2010-2014) of a cohort study of Australian GP registrars' (vocational trainees') consultations. Registrars from five regional training programs recorded data from 60 consecutive consultations, once each 6-month training Term, including the diagnoses managed and medications prescribed. The outcomes were whether an antibiotic was prescribed for the diagnoses 'upper respiratory tract infection (URTI)' and 'acute bronchitis/bronchiolitis'. Generalized linear mixed modelling was used to account for repeated measures on registrars and to include the time component: 'Term'. 

Results: A total of 856 registrars recorded 108759 consultations, including 8715 'URTI' diagnoses (5.15% of diagnoses) and 2110 'acute bronchitis/bronchiolitis' diagnoses (1.25%). Antibiotics were prescribed in 16.3% [95% confidence interval (CI) 14.9-17.8] of URTI and 72.2% (95% CI 69.6-74.6) of acute bronchitis/bronchiolitis diagnoses. Moving from an earlier to later term did not significantly influence registrars' antibiotic prescribing for URTI [adjusted odds ratio (OR) 0.95; 95% CI 0.87, 1.04, P = 0.27] or acute bronchitis/bronchiolitis [OR 1.01 (95% CI 0.90-1.14), P = 0.86]. Significant associations of antibiotic prescribing for URTIs were the registrar being non-Australian educated, greater patient age, practices not privately billing patients, pathology being ordered, longer consultation duration and the registrar seeking in-consultation information or advice (including from their supervisor). 

Conclusions: Early-career experience/training failed to produce rational antibiotic prescribing for URTI and acute bronchitis/bronchiolitis. Our findings suggest that prescribing interventions could target the registrar-supervisor dyad.

Original languageEnglish
Pages (from-to)360-367
Number of pages8
JournalFamily Practice
Volume33
Issue number4
DOIs
Publication statusPublished - 1 Aug 2016

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Bronchitis
Family Physicians
Respiratory Tract Infections
Multicenter Studies
Longitudinal Studies
Bronchiolitis
Anti-Bacterial Agents
Referral and Consultation
Confidence Intervals
Odds Ratio
Inappropriate Prescribing
Family Practice
Cohort Studies
Pathology
Education

Cite this

Magin, Parker J. ; Morgan, Simon ; Tapley, Amanda ; Henderson, Kim M. ; Holliday, Elizabeth G. ; Ball, Jean ; Davis, Joshua S. ; Dallas, Anthea ; Davey, Andrew R. ; Spike, Neil A. ; McArthur, Lawrie ; Stewart, Rebecca ; Mulquiney, Katie J. ; van Driel, Mieke L. / Changes in early-career family physicians' antibiotic prescribing for upper respiratory tract infection and acute bronchitis : A multicentre longitudinal study. In: Family Practice. 2016 ; Vol. 33, No. 4. pp. 360-367.
@article{27991f8dacf244e78c0ba0489a83cc15,
title = "Changes in early-career family physicians' antibiotic prescribing for upper respiratory tract infection and acute bronchitis: A multicentre longitudinal study",
abstract = "Background: Inappropriate antibiotic prescription and subsequent antibacterial resistance are major threats to health worldwide. Objectives: We aimed to establish whether early-career 'apprenticeship-model' experience in family practice influences antibiotic prescribing for respiratory tract infections and to also establish other associations of antibiotic prescribing changes during this early-career experience. Methods: A longitudinal analysis (2010-2014) of a cohort study of Australian GP registrars' (vocational trainees') consultations. Registrars from five regional training programs recorded data from 60 consecutive consultations, once each 6-month training Term, including the diagnoses managed and medications prescribed. The outcomes were whether an antibiotic was prescribed for the diagnoses 'upper respiratory tract infection (URTI)' and 'acute bronchitis/bronchiolitis'. Generalized linear mixed modelling was used to account for repeated measures on registrars and to include the time component: 'Term'. Results: A total of 856 registrars recorded 108759 consultations, including 8715 'URTI' diagnoses (5.15{\%} of diagnoses) and 2110 'acute bronchitis/bronchiolitis' diagnoses (1.25{\%}). Antibiotics were prescribed in 16.3{\%} [95{\%} confidence interval (CI) 14.9-17.8] of URTI and 72.2{\%} (95{\%} CI 69.6-74.6) of acute bronchitis/bronchiolitis diagnoses. Moving from an earlier to later term did not significantly influence registrars' antibiotic prescribing for URTI [adjusted odds ratio (OR) 0.95; 95{\%} CI 0.87, 1.04, P = 0.27] or acute bronchitis/bronchiolitis [OR 1.01 (95{\%} CI 0.90-1.14), P = 0.86]. Significant associations of antibiotic prescribing for URTIs were the registrar being non-Australian educated, greater patient age, practices not privately billing patients, pathology being ordered, longer consultation duration and the registrar seeking in-consultation information or advice (including from their supervisor). Conclusions: Early-career experience/training failed to produce rational antibiotic prescribing for URTI and acute bronchitis/bronchiolitis. Our findings suggest that prescribing interventions could target the registrar-supervisor dyad.",
keywords = "Antibacterial agents, Family practice, General practice, Inappropriate prescribing, Physician practice patterns, Respiratory tract infections",
author = "Magin, {Parker J.} and Simon Morgan and Amanda Tapley and Henderson, {Kim M.} and Holliday, {Elizabeth G.} and Jean Ball and Davis, {Joshua S.} and Anthea Dallas and Davey, {Andrew R.} and Spike, {Neil A.} and Lawrie McArthur and Rebecca Stewart and Mulquiney, {Katie J.} and {van Driel}, {Mieke L.}",
year = "2016",
month = "8",
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doi = "10.1093/fampra/cmw025",
language = "English",
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pages = "360--367",
journal = "Family Practice",
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}

Magin, PJ, Morgan, S, Tapley, A, Henderson, KM, Holliday, EG, Ball, J, Davis, JS, Dallas, A, Davey, AR, Spike, NA, McArthur, L, Stewart, R, Mulquiney, KJ & van Driel, ML 2016, 'Changes in early-career family physicians' antibiotic prescribing for upper respiratory tract infection and acute bronchitis: A multicentre longitudinal study', Family Practice, vol. 33, no. 4, pp. 360-367. https://doi.org/10.1093/fampra/cmw025

Changes in early-career family physicians' antibiotic prescribing for upper respiratory tract infection and acute bronchitis : A multicentre longitudinal study. / Magin, Parker J.; Morgan, Simon; Tapley, Amanda; Henderson, Kim M.; Holliday, Elizabeth G.; Ball, Jean; Davis, Joshua S.; Dallas, Anthea; Davey, Andrew R.; Spike, Neil A.; McArthur, Lawrie; Stewart, Rebecca; Mulquiney, Katie J.; van Driel, Mieke L.

In: Family Practice, Vol. 33, No. 4, 01.08.2016, p. 360-367.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Changes in early-career family physicians' antibiotic prescribing for upper respiratory tract infection and acute bronchitis

T2 - A multicentre longitudinal study

AU - Magin, Parker J.

AU - Morgan, Simon

AU - Tapley, Amanda

AU - Henderson, Kim M.

AU - Holliday, Elizabeth G.

AU - Ball, Jean

AU - Davis, Joshua S.

AU - Dallas, Anthea

AU - Davey, Andrew R.

AU - Spike, Neil A.

AU - McArthur, Lawrie

AU - Stewart, Rebecca

AU - Mulquiney, Katie J.

AU - van Driel, Mieke L.

PY - 2016/8/1

Y1 - 2016/8/1

N2 - Background: Inappropriate antibiotic prescription and subsequent antibacterial resistance are major threats to health worldwide. Objectives: We aimed to establish whether early-career 'apprenticeship-model' experience in family practice influences antibiotic prescribing for respiratory tract infections and to also establish other associations of antibiotic prescribing changes during this early-career experience. Methods: A longitudinal analysis (2010-2014) of a cohort study of Australian GP registrars' (vocational trainees') consultations. Registrars from five regional training programs recorded data from 60 consecutive consultations, once each 6-month training Term, including the diagnoses managed and medications prescribed. The outcomes were whether an antibiotic was prescribed for the diagnoses 'upper respiratory tract infection (URTI)' and 'acute bronchitis/bronchiolitis'. Generalized linear mixed modelling was used to account for repeated measures on registrars and to include the time component: 'Term'. Results: A total of 856 registrars recorded 108759 consultations, including 8715 'URTI' diagnoses (5.15% of diagnoses) and 2110 'acute bronchitis/bronchiolitis' diagnoses (1.25%). Antibiotics were prescribed in 16.3% [95% confidence interval (CI) 14.9-17.8] of URTI and 72.2% (95% CI 69.6-74.6) of acute bronchitis/bronchiolitis diagnoses. Moving from an earlier to later term did not significantly influence registrars' antibiotic prescribing for URTI [adjusted odds ratio (OR) 0.95; 95% CI 0.87, 1.04, P = 0.27] or acute bronchitis/bronchiolitis [OR 1.01 (95% CI 0.90-1.14), P = 0.86]. Significant associations of antibiotic prescribing for URTIs were the registrar being non-Australian educated, greater patient age, practices not privately billing patients, pathology being ordered, longer consultation duration and the registrar seeking in-consultation information or advice (including from their supervisor). Conclusions: Early-career experience/training failed to produce rational antibiotic prescribing for URTI and acute bronchitis/bronchiolitis. Our findings suggest that prescribing interventions could target the registrar-supervisor dyad.

AB - Background: Inappropriate antibiotic prescription and subsequent antibacterial resistance are major threats to health worldwide. Objectives: We aimed to establish whether early-career 'apprenticeship-model' experience in family practice influences antibiotic prescribing for respiratory tract infections and to also establish other associations of antibiotic prescribing changes during this early-career experience. Methods: A longitudinal analysis (2010-2014) of a cohort study of Australian GP registrars' (vocational trainees') consultations. Registrars from five regional training programs recorded data from 60 consecutive consultations, once each 6-month training Term, including the diagnoses managed and medications prescribed. The outcomes were whether an antibiotic was prescribed for the diagnoses 'upper respiratory tract infection (URTI)' and 'acute bronchitis/bronchiolitis'. Generalized linear mixed modelling was used to account for repeated measures on registrars and to include the time component: 'Term'. Results: A total of 856 registrars recorded 108759 consultations, including 8715 'URTI' diagnoses (5.15% of diagnoses) and 2110 'acute bronchitis/bronchiolitis' diagnoses (1.25%). Antibiotics were prescribed in 16.3% [95% confidence interval (CI) 14.9-17.8] of URTI and 72.2% (95% CI 69.6-74.6) of acute bronchitis/bronchiolitis diagnoses. Moving from an earlier to later term did not significantly influence registrars' antibiotic prescribing for URTI [adjusted odds ratio (OR) 0.95; 95% CI 0.87, 1.04, P = 0.27] or acute bronchitis/bronchiolitis [OR 1.01 (95% CI 0.90-1.14), P = 0.86]. Significant associations of antibiotic prescribing for URTIs were the registrar being non-Australian educated, greater patient age, practices not privately billing patients, pathology being ordered, longer consultation duration and the registrar seeking in-consultation information or advice (including from their supervisor). Conclusions: Early-career experience/training failed to produce rational antibiotic prescribing for URTI and acute bronchitis/bronchiolitis. Our findings suggest that prescribing interventions could target the registrar-supervisor dyad.

KW - Antibacterial agents

KW - Family practice

KW - General practice

KW - Inappropriate prescribing

KW - Physician practice patterns

KW - Respiratory tract infections

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DO - 10.1093/fampra/cmw025

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JO - Family Practice

JF - Family Practice

SN - 0263-2136

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