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",
    day = "1",
    doi = "10.1093/fampra/cmw025",
    language = "English",
    volume = "33",
    pages = "360--367",
    journal = "Family Practice",
    issn = "0263-2136",
    publisher = "Oxford University Press",
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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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    U2 - 10.1093/fampra/cmw025

    DO - 10.1093/fampra/cmw025

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    EP - 367

    JO - Family Practice

    JF - Family Practice

    SN - 0263-2136

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