Abstract
BackgroundAntibiotics are overused for non-pneumonia acute respiratory tract infections (ARTIs).AimTo establish prevalence and explore associations of delayed and immediate antibiotic prescribing strategies of Australian early-career GPs (specialist GP vocational trainees, also known as GP registrars) for non-pneumonia ARTIs.Design and settingCross-sectional analysis of data collected between September 2016 and December 2017 from the Registrar Clinical Encounters in Training cohort (ReCEnT) study, an ongoing cohort study of GP registrars’ in-practice clinical experiences in four Australian states and territories.MethodMultinomial logistic regression with outcome antibiotic prescribing (no prescribing, immediate prescribing, and delayed prescribing).ResultsOf 7156 new ARTI diagnoses, no antibiotics were prescribed for 4892 (68%); antibiotics were prescribed for immediate use for 1614 diagnoses (23%) and delayed antibiotics were used for 650 diagnoses (9%). Delayed prescribing was used in 22% of otitis media, 16% of sinusitis, 13% of sore throat, 11% of acute bronchitis/bronchiolitis, and 5% of upper respiratory tract infection (URTI) diagnoses. Delayed prescribing was used for 29% of all prescriptions written. Delayed prescribing and immediate prescribing were associated with markers of clinical concern. Delayed prescribing was associated with longer duration of consultation and with fewer diagnoses/problems dealt with in the consultation.ConclusionAustralian early-career GPs use no prescribing for ARTIs substantially more than established GPs; however, except where URTIs are concerned, they still prescribe antibiotics in excess of validated benchmarks. Australian early-career GPs may use delayed prescribing more often than European established GPs, and may use it to manage diagnostic uncertainty and, possibly, conflicting influences on prescribing behaviour. The use of delayed prescribing may enable a transition to an environment of more-rational antibiotic prescribing for ARTIs.
Highlights
IntroductionAntibiotic resistance and rational antibiotic use are national priorities in Australia, but antibiotics remain overused for non-pneumonia acute respiratory tract infections (ARTIs).(1, 2) ARTIs are common presentations to general practitioners (GPs).(3) In 2017, 41.5% (n=10,215,109) of the Australian population were dispensed at least one systemic antibiotic in primary care, and Australia is in the highest 25% of countries in rates of community antibiotic use.[2, 4]When managing ARTIs, antibiotics are mostly not indicated.[1]
Of 7,156 new ARTI diagnoses, no antibiotics were prescribed for 4,892(68%), antibiotics were prescribed for immediate use for 1,614 diagnoses (23%) and delayed antibiotics were used for 650 diagnoses (9%)
In this study we aimed to describe the prevalence of antibiotic prescribing strategies (‘immediate prescribing’, ‘delayed prescribing’, and ‘no prescribing’) used by Australian early-career GPs for initial presentations of non-pneumonia ARTIs
Summary
IntroductionAntibiotic resistance and rational antibiotic use are national priorities in Australia, but antibiotics remain overused for non-pneumonia acute respiratory tract infections (ARTIs).(1, 2) ARTIs are common presentations to general practitioners (GPs).(3) In 2017, 41.5% (n=10,215,109) of the Australian population were dispensed at least one systemic antibiotic in primary care, and Australia is in the highest 25% of countries (compared with European countries and Canada) in rates of community antibiotic use.[2, 4]When managing ARTIs, antibiotics are mostly not indicated.[1]. General practice training is an important time for early-career GPs, during which they develop approaches to diagnosing and managing ARTIs, including antibiotic prescribing practices. In this study we aimed to describe the prevalence of antibiotic prescribing strategies (‘immediate prescribing’, ‘delayed prescribing’, and ‘no prescribing’) used by Australian early-career GPs (specialist GP vocational trainees or ‘registrars’) for initial presentations of non-pneumonia ARTIs. We aimed to establish the determinants of registrars’ choice of prescribing strategy. Antibiotics are overused for non-pneumonia acute respiratory tract infections (ARTIs). Aim: To establish prevalence and explore associations of delayed and immediate antibiotic prescribing strategies of Australian early-career GPs for non-pneumonia ARTIs. Design and Setting: Cross-sectional analysis of data, September 2016 to December 2017, from the Registrar Clinical Encounters in Training cohort study. “Delayed prescribing” was associated with longer duration of consultation and with fewer diagnoses/problems dealt with in the consultation
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