Age-related decline in antibiotic prescribing for uncomplicated respiratory tract infections in primary care in England following the introduction of a national financial incentive (the Quality Premium) for health commissioners to reduce use of antibiotics in the community: an interrupted time series analysis

被引：53

作者：

Bou-Antoun, Sabine ^{[1
,2
]}

Costelloe, Ceire ^{[1
]}

Honeyford, Kate ^{[1
,2
]}

Mazidi, Mahsa ^{[2
]}

Hayhoe, Benedict W. J. ^{[2
]}

Holmes, Alison ^{[1
]}

Johnson, Alan P. ^{[1
,3
]}

Aylin, Paul ^{[1
,2
]}

机构：

[1] Imperial Coll London, Healthcare Associated Infect & Antimicrobial Resi, NIHR Hlth Protect Res Unit, London, England

[2] Imperial Coll London, Dept Primary Care & Publ Hlth, London, England

[3] Publ Hlth England, Natl Infect Serv, Dept Healthcare Associated Infect & Antimicrobial, London, England

来源：

JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY | 2018年 / 73卷 / 10期

基金：

美国国家卫生研究院;

关键词：

REGRESSION; CONSULTATIONS; RESISTANCE;

D O I：

10.1093/jac/dky237

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

Objectives: To assess the impact of the 2015/16 NHS England Quality Premium (which provided a financial incentive for Clinical Commissioning Groups to reduce antibiotic prescribing in primary care) on antibiotic prescribing by General Practitioners (GPs) for respiratory tract infections (RTIs). Methods: Interrupted time series analysis using monthly patient-level consultation and prescribing data obtained from the Clinical Practice Research Datalink (CPRD) between April 2011 and March 2017. The study population comprised patients consulting a GP who were diagnosed with an RTI. We assessed the rate of antibiotic prescribing in patients (both aggregate and stratified by age) with a recorded diagnosis of uncomplicated RTI, before and after the implementation of the Quality Premium. Results: Prescribing rates decreased over the 6 year study period, with evident seasonality. Notably, there was a 3% drop in the rate of antibiotic prescribing (equating to 14.65 prescriptions per 1000 RTI consultations) (P < 0.05) in April 2015, coinciding with the introduction of the Quality Premium. This reduction was sustained, such that after 2 years there was a 3% decrease in prescribing relative to that expected had the pre-intervention trend continued. There was also a concurrent 2% relative reduction in the rate of broad-spectrum antibiotic prescribing. Antibiotic prescribing for RTIs diagnosed in children showed the greatest decline with a 6% relative change 2 years after the intervention. Of the RTI indications studied, the greatest reductions in antibiotic prescribing were seen for patients with sore throats. Conclusions: Community prescribing of antibiotics for RTIs significantly decreased following the introduction of the Quality Premium, with the greatest reduction seen in younger patients.

引用

页码：2883 / 2892

页数：10