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Reducing antibiotic prescribing in primary care in England from 2014 to 2017: population-based cohort study
OBJECTIVE: To analyse individual-patient electronic health records to evaluate changes in antibiotic (AB) prescribing in England for different age groups, for male and female subjects, and by prescribing indications from 2014 to 2017. METHODS: Data were analysed for 102 general practices in England...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6661619/ https://www.ncbi.nlm.nih.gov/pubmed/31289049 http://dx.doi.org/10.1136/bmjopen-2018-023989 |
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author | Sun, Xiaohui Gulliford, Martin C |
author_facet | Sun, Xiaohui Gulliford, Martin C |
author_sort | Sun, Xiaohui |
collection | PubMed |
description | OBJECTIVE: To analyse individual-patient electronic health records to evaluate changes in antibiotic (AB) prescribing in England for different age groups, for male and female subjects, and by prescribing indications from 2014 to 2017. METHODS: Data were analysed for 102 general practices in England that contributed data to the UK Clinical Practice Research Datalink (CPRD) from 2014 to 2017. Prescriptions for all ABs and for broad-spectrum β-lactam ABs were evaluated. Relative rate reductions (RRR) were estimated from a random-effects Poisson model, adjusting for age, gender, and general practice. RESULTS: Total AB prescribing declined from 608 prescriptions per 1000 person-years in 2014 to 489 per 1000 person-years in 2017; RRR 6.9% (95% CI 6.6% to 7.1%) per year. Broad-spectrum β-lactam AB prescribing decreased from 221 per 1000 person-years in 2014 to 163 per 1000 person-years in 2017; RRR 9.3% (9.0% to 9.6%) per year. Declines in AB prescribing were similar for men and women but the rate of decline was lower over the age of 55 years than for younger patients. All AB prescribing declined by 9.8% (9.6% to 10.1%) per year for respiratory infections, 5.7% (5.2% to 6.2%) for genitourinary infections, but by 3.8% (3.1% to 4.5%) for no recorded indication. Overall, 38.8% of AB prescriptions were associated with codes that did not suggest specific clinical conditions, and 15.3% of AB prescriptions had no medical codes recorded. CONCLUSION: Antibiotic prescribing has reduced and become more selective but substantial unnecessary AB use may persist. Improving the quality of diagnostic coding for AB use will help to support antimicrobial stewardship efforts. |
format | Online Article Text |
id | pubmed-6661619 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-66616192019-08-07 Reducing antibiotic prescribing in primary care in England from 2014 to 2017: population-based cohort study Sun, Xiaohui Gulliford, Martin C BMJ Open Epidemiology OBJECTIVE: To analyse individual-patient electronic health records to evaluate changes in antibiotic (AB) prescribing in England for different age groups, for male and female subjects, and by prescribing indications from 2014 to 2017. METHODS: Data were analysed for 102 general practices in England that contributed data to the UK Clinical Practice Research Datalink (CPRD) from 2014 to 2017. Prescriptions for all ABs and for broad-spectrum β-lactam ABs were evaluated. Relative rate reductions (RRR) were estimated from a random-effects Poisson model, adjusting for age, gender, and general practice. RESULTS: Total AB prescribing declined from 608 prescriptions per 1000 person-years in 2014 to 489 per 1000 person-years in 2017; RRR 6.9% (95% CI 6.6% to 7.1%) per year. Broad-spectrum β-lactam AB prescribing decreased from 221 per 1000 person-years in 2014 to 163 per 1000 person-years in 2017; RRR 9.3% (9.0% to 9.6%) per year. Declines in AB prescribing were similar for men and women but the rate of decline was lower over the age of 55 years than for younger patients. All AB prescribing declined by 9.8% (9.6% to 10.1%) per year for respiratory infections, 5.7% (5.2% to 6.2%) for genitourinary infections, but by 3.8% (3.1% to 4.5%) for no recorded indication. Overall, 38.8% of AB prescriptions were associated with codes that did not suggest specific clinical conditions, and 15.3% of AB prescriptions had no medical codes recorded. CONCLUSION: Antibiotic prescribing has reduced and become more selective but substantial unnecessary AB use may persist. Improving the quality of diagnostic coding for AB use will help to support antimicrobial stewardship efforts. BMJ Publishing Group 2019-07-09 /pmc/articles/PMC6661619/ /pubmed/31289049 http://dx.doi.org/10.1136/bmjopen-2018-023989 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Epidemiology Sun, Xiaohui Gulliford, Martin C Reducing antibiotic prescribing in primary care in England from 2014 to 2017: population-based cohort study |
title | Reducing antibiotic prescribing in primary care in England from 2014 to 2017: population-based cohort study |
title_full | Reducing antibiotic prescribing in primary care in England from 2014 to 2017: population-based cohort study |
title_fullStr | Reducing antibiotic prescribing in primary care in England from 2014 to 2017: population-based cohort study |
title_full_unstemmed | Reducing antibiotic prescribing in primary care in England from 2014 to 2017: population-based cohort study |
title_short | Reducing antibiotic prescribing in primary care in England from 2014 to 2017: population-based cohort study |
title_sort | reducing antibiotic prescribing in primary care in england from 2014 to 2017: population-based cohort study |
topic | Epidemiology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6661619/ https://www.ncbi.nlm.nih.gov/pubmed/31289049 http://dx.doi.org/10.1136/bmjopen-2018-023989 |
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