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

Sabine Bou-Antoun*, Ceire Costelloe, Kate Honeyford, Mahsa Mazidi, Benedict W.J. Hayhoe, Alison Holmes, Alan Johnson, Paul Aylin

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

26 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)2883-2892
Number of pages10
JournalJournal of Antimicrobial Chemotherapy
Volume73
Issue number10
DOIs
Publication statusPublished - 1 Oct 2018

Bibliographical note

Funding Information:
The research was funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London in partnership with PHE, in collaboration with The Sanger Institute, the University of Cambridge Veterinary School and Imperial College Health Partners.

Funding Information:
A. H. acknowledges the support of the Imperial College Healthcare Trust NIHR Biomedical Research Centre (BRC).

Funding Information:
C. C. is supported by an NIHR Career Development fellowship (CDF-2016–09-015).

Funding Information:
We thank Fran Husson and Tim Sims, who are the patient representatives for the Health Protection Research Unit, for their review of the research proposal for this work. The research was funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London in partnership with PHE, in collaboration with The Sanger Institute, the University of Cambridge Veterinary School and Imperial College Health Partners. C. C. is supported by an NIHR Career Development fellowship (CDF-2016–09-015). A. H. acknowledges the support of the Imperial College Healthcare Trust NIHR Biomedical Research Centre (BRC).

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