Immediate and delayed antibiotic prescribing strategies used by Australian early-career GPs: A cross-sectional analysis

Andrew Davey; Amanda Tapley; Katie J. Mulquiney; Mieke Van Driel; Alison Fielding; Elizabeth Holliday; Joshua S. Davis; Paul Glasziou; Anthea Dallas; Jean Ball; Neil Spike; Kristen FitzGerald; Parker Magin

doi:10.3399/BJGP.2021.0026

Immediate and delayed antibiotic prescribing strategies used by Australian early-career GPs: A cross-sectional analysis

Andrew Davey, Amanda Tapley, Katie J. Mulquiney, Mieke Van Driel, Alison Fielding, Elizabeth Holliday, Joshua S. Davis, Paul Glasziou, Anthea Dallas, Jean Ball, Neil Spike, Kristen FitzGerald, Parker Magin

Global and Tropical Health

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Abstract

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.

Original language	English
Pages (from-to)	E895-E903
Number of pages	9
Journal	British Journal of General Practice
Volume	71
Issue number	713
DOIs	https://doi.org/10.3399/BJGP.2021.0026
Publication status	Published - Dec 2021

Bibliographical note

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.

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10.3399/BJGP.2021.0026

49197248-oaFinal published version, 123 KBLicence: CC BY

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Davey, A., Tapley, A., Mulquiney, K. J., Van Driel, M., Fielding, A., Holliday, E., Davis, J. S., Glasziou, P., Dallas, A., Ball, J., Spike, N., FitzGerald, K., & Magin, P. (2021). Immediate and delayed antibiotic prescribing strategies used by Australian early-career GPs: A cross-sectional analysis. British Journal of General Practice, 71(713), E895-E903. https://doi.org/10.3399/BJGP.2021.0026

@article{4c4749ecb82f44e1bb91c9faa2c7ddbf,

title = "Immediate and delayed antibiotic prescribing strategies used by Australian early-career GPs: A cross-sectional analysis",

abstract = "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.",

keywords = "Antibiotics, Family practice, General practice, Primary health care, Respiratory tract infections",

author = "Andrew Davey and Amanda Tapley and Mulquiney, {Katie J.} and {Van Driel}, Mieke and Alison Fielding and Elizabeth Holliday and Davis, {Joshua S.} and Paul Glasziou and Anthea Dallas and Jean Ball and Neil Spike and Kristen FitzGerald and Parker Magin",

note = "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: {\textcopyright} 2021 Royal College of General Practitioners. All rights reserved. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2021",

month = dec,

doi = "10.3399/BJGP.2021.0026",

language = "English",

volume = "71",

pages = "E895--E903",

journal = "British Journal of General Practice",

issn = "0960-1643",

publisher = "Royal College of General Practitioners",

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Davey, A, Tapley, A, Mulquiney, KJ, Van Driel, M, Fielding, A, Holliday, E, Davis, JS, Glasziou, P, Dallas, A, Ball, J, Spike, N, FitzGerald, K & Magin, P 2021, 'Immediate and delayed antibiotic prescribing strategies used by Australian early-career GPs: A cross-sectional analysis', British Journal of General Practice, vol. 71, no. 713, pp. E895-E903. https://doi.org/10.3399/BJGP.2021.0026

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

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U2 - 10.3399/BJGP.2021.0026

DO - 10.3399/BJGP.2021.0026

M3 - Article

C2 - 34097641

AN - SCOPUS:85120453459

SN - 0960-1643

VL - 71

SP - E895-E903

JO - British Journal of General Practice

JF - British Journal of General Practice

IS - 713

ER -

Immediate and delayed antibiotic prescribing strategies used by Australian early-career GPs: A cross-sectional analysis

Abstract

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