Abstract
BackgroundThe rise in antibiotic resistance is a global public health concern, and antibiotic overuse needs to be reduced. Earlier studies of out-of-hours care have indicated that antibiotic prescribing is less appropriate than that of in-hours care. However, no study has compared the out-of-hours treatment of infections to in-hours treatment within the same population.MethodsThis retrospective, descriptive study was based on data retrieved from the Kronoberg Infection Database in Primary Care (KIDPC), which consists of all visits to primary care with an infection diagnosis or prescription of antibiotics during 2006–2014. The purpose was to study the trends in antibiotic prescribing and to compare consultations and prescriptions between in-hours and out-of-hours.ResultsThe visit rate for all infections was 434 visits per 1000 inhabitants per year. The visit rate was stable during the study period, but the antibiotic prescribing rate decreased from 266 prescriptions per 1000 inhabitants in 2006 to 194 prescriptions in 2014 (mean annual change − 8.5 [95% CI − 11.9 to − 5.2]). For the out-of-hours visits (12% of the total visits), a similar reduction in antibiotic prescribing was seen. The decrease was most apparent among children and in respiratory tract infections.When antibiotic prescribing during out-of-hours was compared to in-hours, the unadjusted relative risk of antibiotic prescribing was 1.37 (95% CI 1.36 to 1.38), but when adjusted for age, sex, and diagnosis, the relative risk of antibiotic prescribing was 1.09 (95% CI 1.08 to 1.10). The reduction after adjustment was largely explained by a higher visit rate during out-of-hours for infections requiring antibiotics (acute otitis media, pharyngotonsillitis, and lower urinary tract infection). The choices of antibiotics used for common diagnoses were similar.ConclusionsAlthough the infection visit rate was unchanged over the study period, there was a significant reduction in antibiotic prescribing, especially to children and for respiratory tract infections. The higher antibiotic prescribing rate during out-of-hours was small when adjusted for age, sex, and diagnosis. No excess prescription of broad-spectrum antibiotics was seen. Therefore, interventions selectively aiming at out-of-hours centres seem to be unmotivated in a low-prescribing context.
Highlights
The rise in antibiotic resistance is a global public health concern, and antibiotic overuse needs to be reduced
No significant trends were observed in total visit rate nor in visit rate by sex, but the mean annual change in visit rate per 1000 inhabitants per year decreased in children 0–4 years (− 33.7), increased in adults 65–79 years (7.7 and in adults over 80 years (13.9) (Tables 1 and 2)
This study showed that women visited primary care for infections more often than men and received antibiotic treatment more often than men
Summary
The rise in antibiotic resistance is a global public health concern, and antibiotic overuse needs to be reduced. Earlier studies of out-of-hours care have indicated that antibiotic prescribing is less appropriate than that of in-hours care. Studies on antibiotic prescribing in primary care regardless of indication show a high level of variability between physicians in different countries [3,4,5]. Earlier studies of OOH care have suggested that compared to IH care there are lower adherence to antibiotic guidelines [6, 7], a higher antibiotic prescribing rate [8, 9], a higher rate of prescriptions for broad-spectrum antibiotics [8], and more antibiotic prescriptions during weekends than weekday evenings [10]. A more recent Belgian OOH study showed a high antibiotic prescribing rate for all indications, a high rate of not using recommended antibiotics, and an overuse of quinolones [12]. No previous study has compared the OOH treatment of infections to IH within the same population
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