Anthea Dallas1, Parker Magin2, Simon Morgan3, Amanda Tapley3, Kim Henderson3, Jean Ball4, John Scott3, Neil Spike5, Lawrie McArthur6, Mieke van Driel7. 1. Discipline of General Practice, University of Queensland, Brisbane, anthea.dallas@nd.edu.au. 2. Discipline of General Practice, University of Newcastle, Newcastle, General Practice Training - Valley to Coast, Newcastle. 3. General Practice Training - Valley to Coast, Newcastle. 4. HMRI/CReDITTS, Newcastle. 5. Victorian Metropolitan Alliance General Practice Training, Melbourne, Department of General Practice, University of Melbourne, Melbourne and. 6. Adelaide to Outback GP Training Program, Adelaide, Australia. 7. Discipline of General Practice, University of Queensland, Brisbane.
Abstract
BACKGROUND: Antibiotic resistance is among the most important current public health issues. Most antibiotics are prescribed in primary care. There is strong consensus that they are overprescribed, especially for conditions such as upper respiratory tract infections (URTI) and acute bronchitis, where they provide limited benefit. Interventions to alter prescribing patterns have shown limited effect. Trainees in family practice may be an appropriate target, as their prescribing habits are still developing. OBJECTIVE: To establish prevalence and associations of trainee prescribing of antibiotics for URTI and acute bronchitis/bronchiolitis. METHODS: A cross-sectional analysis of the Registrar Clinical Encounters in Training (ReCEnT) study. ReCEnT is an ongoing cohort study of Australian General Practice (GP) trainees documenting the nature of their consultation-based clinical experiences. Trainees record details of 60 consecutive patient encounters every 6-month training term. Univariate and logistic regression analyses were conducted on data recorded in consultations related to URTI and acute bronchitis/bronchiolitis in six collection periods during 2010-12. RESULTS: Data from 401 trainees (94.7% response rate) were analysed. Antibiotics were prescribed in 21.6% of encounters for URTI and 73.1% of encounters for acute bronchitis/bronchiolitis. Trainees prescribing antibiotics were more likely to order tests, and to seek in-consultation advice. Logistic regression analysis demonstrated older patient age, Indigenous patient background, and practices in higher socioeconomic areas were significant predictors of antibiotic prescribing. CONCLUSION: GP trainee antibiotic prescribing is higher than justified by guidelines. Understanding factors contributing to this pattern will assist in developing educational interventions to improve evidence-based prescribing habits during the early stages of these doctors' careers.
BACKGROUND: Antibiotic resistance is among the most important current public health issues. Most antibiotics are prescribed in primary care. There is strong consensus that they are overprescribed, especially for conditions such as upper respiratory tract infections (URTI) and acute bronchitis, where they provide limited benefit. Interventions to alter prescribing patterns have shown limited effect. Trainees in family practice may be an appropriate target, as their prescribing habits are still developing. OBJECTIVE: To establish prevalence and associations of trainee prescribing of antibiotics for URTI and acute bronchitis/bronchiolitis. METHODS: A cross-sectional analysis of the Registrar Clinical Encounters in Training (ReCEnT) study. ReCEnT is an ongoing cohort study of Australian General Practice (GP) trainees documenting the nature of their consultation-based clinical experiences. Trainees record details of 60 consecutive patient encounters every 6-month training term. Univariate and logistic regression analyses were conducted on data recorded in consultations related to URTI and acute bronchitis/bronchiolitis in six collection periods during 2010-12. RESULTS: Data from 401 trainees (94.7% response rate) were analysed. Antibiotics were prescribed in 21.6% of encounters for URTI and 73.1% of encounters for acute bronchitis/bronchiolitis. Trainees prescribing antibiotics were more likely to order tests, and to seek in-consultation advice. Logistic regression analysis demonstrated older patient age, Indigenous patient background, and practices in higher socioeconomic areas were significant predictors of antibiotic prescribing. CONCLUSION: GP trainee antibiotic prescribing is higher than justified by guidelines. Understanding factors contributing to this pattern will assist in developing educational interventions to improve evidence-based prescribing habits during the early stages of these doctors' careers.
Authors: Parker Magin; Amanda Tapley; Adrian J Dunlop; Andrew Davey; Mieke van Driel; Elizabeth Holliday; Simon Morgan; Kim Henderson; Jean Ball; Nigel Catzikiris; Katie Mulquiney; Neil Spike; Rohan Kerr; Simon Holliday Journal: J Gen Intern Med Date: 2018-07-23 Impact factor: 5.128
Authors: Malene Plejdrup Hansen; Tammy C Hoffmann; Amanda R McCullough; Mieke L van Driel; Chris B Del Mar Journal: Front Public Health Date: 2015-02-24
Authors: Erika A Saliba-Gustafsson; Alexandra Dunberger Hampton; Peter Zarb; Nicola Orsini; Michael A Borg; Cecilia Stålsby Lundborg Journal: BMJ Open Date: 2019-12-18 Impact factor: 2.692
Authors: Mieke L van Driel; Simon Morgan; Amanda Tapley; Lawrie McArthur; Patrick McElduff; Lucy Yardley; Anthea Dallas; Laura Deckx; Katie Mulquiney; Joshua S Davis; Andrew Davey; Kim Henderson; Paul Little; Parker J Magin Journal: BMC Fam Pract Date: 2016-06-06 Impact factor: 2.497