Abstract
IntroductionThe persistent development and spread of resistance to antibiotics remain an important public health concern in the UK and globally. About 74% of antibiotics prescribed in England in 2016 was in primary care. The Quality Premium (QP) initiative that rewards Clinical Commissioning Groups (CCGs) financially based on the quality of specific health services commissioned is one of the National Health Service (NHS) England interventions to reduce antimicrobial resistance through reduced prescribing. Emerging evidence suggests a reduction in antibiotic prescribing in primary care practices in the UK following QP initiative. This study aims to investigate the mechanism of impact of this high-cost health-system level intervention on antibiotic prescribing in primary care practices in England.Methods and analysisThe study will constitute secondary analyses of antibiotic prescribing data for almost all primary care practices in England from the NHS England Antibiotic Quality Premium Monitoring Dashboard and OpenPrescribing covering the period 2013 to 2018. The primary outcome is the number of antibiotic items per Specific Therapeutic group Age-sex Related Prescribing Unit (STAR-PU) prescribed monthly in each practice or CCG. We will first conduct an interrupted time series using ordinary least square regression method to examine whether antibiotic prescribing rate in England has changed over time, and how such changes, if any, are associated with QP implementation. Single and sequential multiple-mediator models using a unified approach for the natural direct and indirect effects will be conducted to investigate the relationship between QP initiative, the potential mediators and antibiotic prescribing rate with adjustment for practice and CCG characteristics.Ethics and disseminationThis study will use secondary data that are anonymised and obtained from studies that have either undergone ethical review or generated data from routine collection systems. Multiple channels will be used in disseminating the findings from this study to academic and non-academic audiences.
Highlights
The persistent development and spread of resistance to antibiotics remain an important public health concern in the UK and globally
Study aim and objectives Using routinely collected population-level data on antibiotic prescribing in England, this study aims to address the research question: What are the mechanisms and mediators of the impact of a high-cost health-system level intervention, the ‘antibiotic prescribing quality premium’? We will investigate the difference in antibiotic prescribing rate pre-Quality Premium (QP) and post-QP initiative to establish its direct, indirect and total effects in reducing antibiotic prescribing in primary care practices in England
Clinical Commissioning Groups (CCGs) were established in England in April 2013 following the Health and Social Care Act 2012.33 Data on antibiotic prescribing in primary care at CCG level will be sourced from the National Health Service (NHS) England Antibiotic Quality Premium Monitoring Dashboard, which is produced by the NHS Business Services Authority (BSA).[34]
Summary
The persistent development and spread of resistance to antibiotics remain an important public health concern in the UK and globally. The Quality Premium (QP) initiative that rewards Clinical Commissioning Groups (CCGs) financially based on the quality of specific health services commissioned is one of the National Health Service (NHS) England interventions to reduce antimicrobial resistance through reduced prescribing. This study aims to investigate the mechanism of impact of this high-cost health-system level intervention on antibiotic prescribing in primary care practices in England. Methods and analysis The study will constitute secondary analyses of antibiotic prescribing data for almost all primary care practices in England from the NHS England Antibiotic Quality Premium Monitoring Dashboard and OpenPrescribing covering the period 2013 to 2018. The persistent development and spread of resistance to antimicrobials, especially antibiotics, remain an important public health
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