Increase in antibiotic prescriptions in out-of-hours primary care in contrast to in-hours primary care prescriptions: service evaluation in a population of 600 000 patients

OBJECTIVES

The objective of this study was to describe the frequency and nature of antibiotic prescriptions issued by a primary care out-of-hours (OOH) service and compare time trends in prescriptions between OOH and in-hours primary care.

METHODS

We performed a retrospective audit of 496 931 patient contacts with the Oxfordshire OOH primary care service. Comparison of time trends in antibiotic prescriptions from OOH primary care and in-hours primary care for the same population was made using multiple linear regression models fitted to the monthly data for OOH prescriptions, OOH contacts and in-hours prescriptions between September 2010 and August 2014.

RESULTS

Compared with the overall population contacting the OOH service, younger age, female sex and patients who were less deprived were independently correlated with an increased chance of a contact resulting in prescription of antibiotics. The majority of antibiotics were prescribed to patients contacting the service at weekends. Despite a reduction in patient contacts with the OOH service [an estimated decrease of 486.5 monthly contacts each year (95% CI -676.3 to -296.8), 5.0% of the average monthly contacts], antibiotic prescriptions from this service rose during the study period [increase of 37.1 monthly prescriptions each year (95% CI 10.6-63.7), 2.5% of the average monthly prescriptions]. A matching increase was not seen for in-hours antibiotic prescriptions; the difference between the year trends was significant (Z test, P = 0.002).

CONCLUSIONS

We have demonstrated trends in prescribing that could represent a partial displacement of antibiotic prescribing from in-hours to OOH primary care. The possibility that the trends we describe are evident nationally should be explored.

Outcome findings from a multidisciplinary clinic for children with epilepsy

Children with chronic or intractable epilepsy are at higher risk for medical and social difficulties. A multidisciplinary clinic was established to improve medical management and address psychosocial issues. The purposes of the present study were to describe the multidisciplinary clinic, retrospectively examine the referral patterns for children served by the clinic, and analyze factors significantly predictive of parental satisfaction with the multidisciplinary approach. The Epilepsy Clinic Satisfaction Questionnaire was sent to all patients seen in the clinic over a 2-year period. Outcome findings were based on 136 respondents. A stepwise regression analysis indicated that the best predictor of parental rating of clinic quality was the amount of information given concerning the diagnosis and treatment of epilepsy. Staff attitude was also significantly related to parental satisfaction.

Clinical and developmental findings in children with giant interhemispheric cysts and dysgenesis of the corpus callosum

Giant interhemispheric cysts in association with dysgenesis of the corpus callosum are rare. Clinical and developmental data concerning affected patients are limited, the pathologic basis for these cysts has not been established, and prognosis is uncertain. The purpose of our study was to describe the clinical and developmental findings for 11 children with giant interhemispheric cysts, dysgenesis of the corpus callosum, and ventricular dilatation. Eight of the children required ventriculoperitoneal shunting, eight had normal neurologic examinations, and seven had experienced seizures. Seizure control appeared to correlate with neurodevelopmental function. Cognitively, children ranged from the average to mildly/moderately retarded level. Language delays were frequent, particularly in children with predominantly left hemispheric cysts. Adaptive behavior was mildly delayed with weakness observed in motor skills. Despite the striking neuroimaging abnormalities, our findings suggest the possibility of only mildly delayed neurodevelopmental outcome is good for children with this constellation of neurologic anomalies.

Use of nonverbal tests to screen for writing dysfluency in school-age children

Writing fluency, the ability to write rapidly and easily, is critical for the timely completion of written assignments in the classroom. Children who possess basic writing skills and have an ability to communicate ideas are often penalized for slowness in completing written tasks. The present study used frequently administered nonverbal tasks to predict performance on the Writing Fluency subtest of the Woodcock-Johnson Tests of Achievement--Revised for 146 subjects from 6 to 16 years old. A stepwise-regression analysis indicated the Coding subtest of the WISC--R, Beery Developmental Test of Visual Motor Integration, the Grooved Pegboard, and gender accounted for 32% of the variance. Logistic regression suggested cut-off scores falling one standard deviation below the mean on Coding and Beery's visuomotor test would signal need for further evaluation of writing dysfluency, particularly for boys.