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Identifying English practices that are high antibiotic prescribers accounting for comorbidities and other legitimate medical reasons for variation
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Hope, Emma C., Crump, Ron E., Hollingsworth, Deirdre, Smieszek, Timo, Robotham, Julie and Pouwels, Koen (2018) Identifying English practices that are high antibiotic prescribers accounting for comorbidities and other legitimate medical reasons for variation. eClinicalMedicine, 6 . pp. 36-41. doi:10.1016/j.eclinm.2018.12.003 ISSN 2589-5370.
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Official URL: https://doi.org/10.1016/j.eclinm.2018.12.003
Abstract
Background: Seeing one’s practice as a high antibiotic prescriber compared to general practices with similar patient populations can be one of the best motivators for change. Current comparisons are based on age-sex weighting of the practice population for expected prescribing rates (STAR-PU). Here, we investigate whether there is a need to additionally account for further potentially legitimate medical reasons for higher antibiotic prescribing. Methods: Publicly available data from 7,376 general practices in England between April 2014 and March 2015 were used. We built two different negative binomial regression models to compare observed versus expected antibiotic dispensing levels per practice: one including comorbidities as covariates and another with the addition of smoking prevalence and deprivation. We compared the ranking of practices in terms of items prescribed per STAR-PU according to i) conventional STAR-PU methodology, ii) observed vs expected prescribing levels using the comorbidity model, and iii) observed vs expected prescribing levels using the full model. Findings: The median number of antibiotic items prescribed per practice per STAR-PU was 1.09 (25th -75th percentile, 0.92-1.25). 1,133 practices (76.8% of 1,476) were consistently identified as being in the top 20% of high antibiotic prescribers. However, some practices that would be classified as high prescribers using the current STAR-PU methodology would not be classified as high prescribers if comorbidity was accounted for (n=269, 18.2%) and if additionally smoking prevalence and deprivation were accounted for (n=312, 21.1%). Interpretation: Current age-sex weighted comparisons of antibiotic prescribing rates in England are fair for many, but not all practices. This new metric that accounts for legitimate medical reasons for higher antibiotic prescribing may have more credibility among general practitioners and, thus, more likely to be acted upon.
| Item Type: | Journal Article | |||||||||
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| Subjects: | Q Science > QA Mathematics R Medicine > RM Therapeutics. Pharmacology |
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| Divisions: | Faculty of Science, Engineering and Medicine > Science > Life Sciences (2010- ) Faculty of Science, Engineering and Medicine > Science > Mathematics |
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| Library of Congress Subject Headings (LCSH): | Antibiotics , Drugs -- Prescribing -- Rating of | |||||||||
| Journal or Publication Title: | eClinicalMedicine | |||||||||
| Publisher: | Elsevier | |||||||||
| ISSN: | 2589-5370 | |||||||||
| Official Date: | 1 December 2018 | |||||||||
| Dates: |
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| Volume: | 6 | |||||||||
| Page Range: | pp. 36-41 | |||||||||
| DOI: | 10.1016/j.eclinm.2018.12.003 | |||||||||
| Status: | Peer Reviewed | |||||||||
| Publication Status: | Published | |||||||||
| Access rights to Published version: | Open Access (Creative Commons) | |||||||||
| Date of first compliant deposit: | 5 December 2018 | |||||||||
| Date of first compliant Open Access: | 7 January 2019 | |||||||||
| RIOXX Funder/Project Grant: |
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