Early-career general practitioners' antibiotic prescribing for acute infections: a systematic review

Contextual Factors that Influence Antibiotic Prescribing: A Discrete Choice Experiment of GP Registrars

INTRODUCTION

Antimicrobial resistance is a global emergency related to overprescribing of antibiotics. Few studies have explored how prescribing behaviours may change as the consequence of changing resistance. Understanding how contextual factors influence antibiotic prescribing will facilitate improved communication strategies to promote appropriate antibiotic prescribing. We aimed to develop and conduct a discrete choice experiment (DCE) to measure how contextual factors influence intended antibiotic prescribing of general practitioner (GP) registrars.

METHODS

Factors included as attributes in the DCE were level of antibiotic resistance, requirement for an authority to prescribe, existence of a Practice Incentives Program (PIP) for low prescribing and supervisor support for low prescribing. The survey was administered in an online format for GP registrars undergoing training between 2020 and 2021. Regression analysis using a conditional logit model with interaction effects was used on the basis of the assumptions of independence of irrelevant alternatives, independence of error terms and no preference heterogeneity.

RESULTS

In total, 617 unique respondents answered at least one choice set question. Respondents showed significant preference for avoiding prescribing antibiotics when antibiotic resistance was 25-35% or 40-60% compared with 5-8%. There was also a significant preference for avoiding prescribing when an authority to prescribe was required, or when there was supervisory support of low antibiotic prescribing. In the main effects analysis, respondents were significantly less likely to choose a prescribing option if there was a PIP; however, when interaction effects were included in the regression analysis there was a significant interaction between PIP and resistance rates, but the preference weights for PIP was no longer significant.

CONCLUSIONS

Knowledge about community resistance impacts the stated intention of GP registrars to prescribe antibiotics. The use of the DCE may have made it possible to determine factors influencing prescribing that would not be detected using other survey methods. These findings provide guidance for producing, explaining and communicating issues regarding antibiotic prescribing to GP registrars.

Burden of antimicrobial prescribing in primary care attributable to sore throat: a retrospective cohort study of patient record data

BACKGROUND

Reducing antibiotic use in Australia, and the subsequent impact on antimicrobial resistance, requires multiple, sustained approaches with appropriate resources and support. Additional strategies to reduce antibiotic prescribing include effective vaccines, against pathogens such as Streptococcus pyogenes, the most common bacterial cause of sore throat. As part of efforts towards assessing the benefits of introducing new strategies to reduce antimicrobial prescribing, we aimed to determine the burden of antimicrobial prescribing for sore throat in general practice.

METHODS

General practice activity data from 2013 - 2017 derived from the first 8 practices participating in the 'Primary Care Audit, Teaching and Research Open Network' (Patron) program were analysed according to reason for visit (upper respiratory tract infection, URTI, or sore throat) and antibiotic prescription. The main outcome measures were percentage of sore throat or URTI presentations with antibiotic prescription by age.

RESULTS

A total of 722,339 visits to general practice were made by 65,449 patients; 5.7% of visits were for URTI with 0.8% meeting the more specific criteria for sore throat. 66.1% of sore throat visits and 36.2% of URTI visits resulted in antibiotic prescription. Penicillin, the recommended antibiotic for sore throat when indicated, was the antibiotic of choice in only 52.9% of sore throat cases prescribed antibiotics. Broader spectrum antibiotics were prescribed more frequently in older age groups.

CONCLUSIONS

Frequency of antibiotic prescribing for sore throat is high and broad, despite Australian Therapeutic guideline recommendations. Multiple, sustained interventions to reduce prescribing, including availability of effective S. pyogenes vaccines that could reduce the incidence of streptococcal pharyngitis, could obviate the need to prescribe antibiotics and support ongoing efforts to promote antimicrobial stewardship.