- Title
- Changes in early-career family physicians' antibiotic prescribing for upper respiratory tract infection and acute bronchitis: a multicentre longitudinal study
- Creator
- Magin, Parker J.; Morgan, Simon; McArthur, Lawrie; Stewart, Rebecca; Mulquiney, Katie J.; van Driel, Mieke L.; Tapley, Amanda; Henderson, Kim M.; Holliday, Elizabeth G.; Ball, Jean; Davis, Joshua S.; Dallas, Anthea; Davey, Andrew R.; Spike, Neil A.
- Relation
- Family Practice Vol. 33, Issue 4, p. 360-367
- Publisher Link
- http://dx.doi.org/10.1093/fampra/cmw025
- Publisher
- Oxford University Press
- Resource Type
- journal article
- Date
- 2016
- Description
- Background: Inappropriate antibiotic prescription and subsequent antibacterial resistance are major threats to health worldwide. Objectives: We aimed to establish whether early-career 'apprenticeship-model' experience in family practice influences antibiotic prescribing for respiratory tract infections and to also establish other associations of antibiotic prescribing changes during this early-career experience. Methods: A longitudinal analysis (2010-2014) of a cohort study of Australian GP registrars' (vocational trainees') consultations. Registrars from five regional training programs recorded data from 60 consecutive consultations, once each 6-month training Term, including the diagnoses managed and medications prescribed. The outcomes were whether an antibiotic was prescribed for the diagnoses 'upper respiratory tract infection (URTI)' and 'acute bronchitis/bronchiolitis'. Generalized linear mixed modelling was used to account for repeated measures on registrars and to include the time component: 'Term'. Results: A total of 856 registrars recorded 108759 consultations, including 8715 'URTI' diagnoses (5.15% of diagnoses) and 2110 'acute bronchitis/bronchiolitis' diagnoses (1.25%). Antibiotics were prescribed in 16.3% [95% confidence interval (CI) 14.9-17.8] of URTI and 72.2% (95% CI 69.6-74.6) of acute bronchitis/bronchiolitis diagnoses. Moving from an earlier to later term did not significantly influence registrars' antibiotic prescribing for URTI [adjusted odds ratio (OR) 0.95; 95% CI 0.87, 1.04, P = 0.27] or acute bronchitis/bronchiolitis [OR 1.01 (95% CI 0.90-1.14), P = 0.86]. Significant associations of antibiotic prescribing for URTIs were the registrar being non-Australian educated, greater patient age, practices not privately billing patients, pathology being ordered, longer consultation duration and the registrar seeking in-consultation information or advice (including from their supervisor). Conclusions: Early-career experience/training failed to produce rational antibiotic prescribing for URTI and acute bronchitis/bronchiolitis. Our findings suggest that prescribing interventions could target the registrar-supervisor dyad.
- Subject
- antibacterial agents; family practice; general practice; inappropriate prescribing; physician prescribing patters; respiratory tract infections
- Identifier
- http://hdl.handle.net/1959.13/1337390
- Identifier
- uon:27836
- Identifier
- ISSN:0263-2136
- Rights
- This is a pre-copyedited, author-produced version of an article accepted for publication in ‘Family Practice’ following peer review. The version of record Magin, Parker J.; Morgan, Simon; McArthur, Lawrie; Stewart, Rebecca; Mulquiney, Katie J.; van Driel, Mieke L.; Tapley, Amanda; Henderson, Kim M.; Holliday, Elizabeth G.; Ball, Jean; Davis, Joshua S.; Dall, Anthea; Spike, Neil A. " Changes in early-career family physicians' antibiotic prescribing for upper respiratory tract infection and acute bronchitis: a multicentre longitudinal study" Published in Family Practice, Vol. 33, Issue 4, pp 360-367, (2016) is available online at: https://academic.oup.com/fampra/article-lookup/doi/10.1093/fampra/cmw025.
- Language
- eng
- Full Text
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