Restricting access to antibiotics: The effectiveness of a 'no repeats' government policy intervention.

Abstract

Australia has a high rate of antibiotic use. Government policy interventions are one strategy to optimise the use of antibiotics. On 1 April 2020, the Australian Government Department of Health introduced a policy intervention to increase the quality use of four antibiotics. To assess if the government policy intervention improved the appropriate supply of the four antibiotics amoxicillin, amoxicillin-clavulanic acid, cefalexin and roxithromycin. This study employed a retrospective cohort study design comparing a 10% sample (n=345,018) of four antibiotics prescribed and dispensed in Australia during a three-month period (May, June, July) in 2019, and again in 2020 (after the policy intervention). The 10% sample of PBS data was obtained from the Australian Government Department of Health. Descriptive statistics, bivariate and multivariable logistic regression analysis were carried out. The results suggest the policy change improved the appropriate supply of original prescriptions in 2020 compared to 2019 OR=1.75 (95% CI=1.68-1.82, p<0.001), and appropriate supply of repeat prescriptions OR=1.56 (95% CI=1.25-1.96, p<0.001). In 2020, the proportion of appropriate supply of original prescriptions increased by an absolute difference of 1.8% (95% CI=1.6-1.9%; P<0.001), and appropriate supply of repeat prescriptions increased by 3.9% (95% CI=2.2-5.5%; P<0.001). The total number of antibiotic prescriptions prescribed and dispensed in 2019 (N=219,960) reduced in 2020 (N=125,058) after the policy intervention. The study provides evidence for the impact of a government policy intervention to improve the appropriate supply of antibiotics, although some of the reduction in antibiotic use was likely due to the concomitant COVID-19 pandemic. Further research is required to assess the impact of the intervention outside a pandemic.