TY - JOUR
T1 - Immediate and delayed antibiotic prescribing strategies used by Australian early-career GPs
T2 - A cross-sectional analysis
AU - Davey, Andrew
AU - Tapley, Amanda
AU - Mulquiney, Katie J.
AU - Van Driel, Mieke
AU - Fielding, Alison
AU - Holliday, Elizabeth
AU - Davis, Joshua S.
AU - Glasziou, Paul
AU - Dallas, Anthea
AU - Ball, Jean
AU - Spike, Neil
AU - FitzGerald, Kristen
AU - Magin, Parker
N1 - Funding Information:
During the data collection period included in this study, funding of the Registrar Clinical Encounters in Training (ReCEnT) study was by an Australian Commonwealth Department of Health Research grant, and supported by GP Synergy, the general practice Regional Training Organisation for New South Wales and the Australian Capital Territory. GP Synergy is funded by the Australian Department of Health. The researchers gratefully acknowledge the Royal Australian College of General Practitioners Foundation for its support of this project (Family Medical Care and Research Grant 2016; reference: FMC16a 609796).
Publisher Copyright:
© 2021 Royal College of General Practitioners. All rights reserved.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/12
Y1 - 2021/12
N2 - Background Antibiotics are overused for non-pneumonia acute respiratory tract infections (ARTIs). Aim To establish prevalence and explore associations of delayed and immediate antibiotic prescribing strategies of Australian early-career GPs (specialist GP vocational trainees, also known as GP registrars) for non-pneumonia ARTIs. Design and setting Cross-sectional analysis of data collected between September 2016 and December 2017 from the Registrar Clinical Encounters in Training cohort (ReCEnT) study, an ongoing cohort study of GP registrars' in-practice clinical experiences in four Australian states and territories. Method Multinomial logistic regression with outcome antibiotic prescribing (no prescribing, immediate prescribing, and delayed prescribing). Results Of 7156 new ARTI diagnoses, no antibiotics were prescribed for 4892 (68%); antibiotics were prescribed for immediate use for 1614 diagnoses (23%) and delayed antibiotics were used for 650 diagnoses (9%). Delayed prescribing was used in 22% of otitis media, 16% of sinusitis, 13% of sore throat, 11% of acute bronchitis/bronchiolitis, and 5% of upper respiratory tract infection (URTI) diagnoses. Delayed prescribing was used for 29% of all prescriptions written. Delayed prescribing and immediate prescribing were associated with markers of clinical concern. Delayed prescribing was associated with longer duration of consultation and with fewer diagnoses/problems dealt with in the consultation. Conclusion Australian early-career GPs use no prescribing for ARTIs substantially more than established GPs; however, except where URTIs are concerned, they still prescribe antibiotics in excess of validated benchmarks. Australian early-career GPs may use delayed prescribing more often than European established GPs, and may use it to manage diagnostic uncertainty and, possibly, conflicting influences on prescribing behaviour. The use of delayed prescribing may enable a transition to an environment of more-rational antibiotic prescribing for ARTIs.
AB - Background Antibiotics are overused for non-pneumonia acute respiratory tract infections (ARTIs). Aim To establish prevalence and explore associations of delayed and immediate antibiotic prescribing strategies of Australian early-career GPs (specialist GP vocational trainees, also known as GP registrars) for non-pneumonia ARTIs. Design and setting Cross-sectional analysis of data collected between September 2016 and December 2017 from the Registrar Clinical Encounters in Training cohort (ReCEnT) study, an ongoing cohort study of GP registrars' in-practice clinical experiences in four Australian states and territories. Method Multinomial logistic regression with outcome antibiotic prescribing (no prescribing, immediate prescribing, and delayed prescribing). Results Of 7156 new ARTI diagnoses, no antibiotics were prescribed for 4892 (68%); antibiotics were prescribed for immediate use for 1614 diagnoses (23%) and delayed antibiotics were used for 650 diagnoses (9%). Delayed prescribing was used in 22% of otitis media, 16% of sinusitis, 13% of sore throat, 11% of acute bronchitis/bronchiolitis, and 5% of upper respiratory tract infection (URTI) diagnoses. Delayed prescribing was used for 29% of all prescriptions written. Delayed prescribing and immediate prescribing were associated with markers of clinical concern. Delayed prescribing was associated with longer duration of consultation and with fewer diagnoses/problems dealt with in the consultation. Conclusion Australian early-career GPs use no prescribing for ARTIs substantially more than established GPs; however, except where URTIs are concerned, they still prescribe antibiotics in excess of validated benchmarks. Australian early-career GPs may use delayed prescribing more often than European established GPs, and may use it to manage diagnostic uncertainty and, possibly, conflicting influences on prescribing behaviour. The use of delayed prescribing may enable a transition to an environment of more-rational antibiotic prescribing for ARTIs.
KW - Antibiotics
KW - Family practice
KW - General practice
KW - Primary health care
KW - Respiratory tract infections
UR - http://www.scopus.com/inward/record.url?scp=85120453459&partnerID=8YFLogxK
U2 - 10.3399/BJGP.2021.0026
DO - 10.3399/BJGP.2021.0026
M3 - Article
C2 - 34097641
AN - SCOPUS:85120453459
VL - 71
SP - E895-E903
JO - British Journal of General Practice
JF - British Journal of General Practice
SN - 0960-1643
IS - 713
ER -