Antimicrobial prescribing in post-graduate training practices: a cross-sectional study of prescribing data in general practices in England

Abstract

Introduction: Seventy-five percent of all antimicrobials are prescribed in primary care. There is a growing concern about inappropriate oral antimicrobial prescribing. Interventions to enhance antimicrobial stewardship are actively promoted through educational and other means. GP training practice status has been shown to influence patient care. This study seeks to study the influence of GP training practice status on antimicrobial prescribing. Methods: A cross-sectional analysis of practice antimicrobial prescribing data was conducted for the year 2015-2016 comparing training and non-training practices across England. Data for all practices and prescribing was obtained from NHS Digital. Univariate analyses were conducted on the two measures of antibiotic prescribing included in the study. Multivariable regression models were constructed to identify the predictors of antibiotic prescribing volumes and of broad spectrum antibiotic prescribing. Results: GP training practice status was a significant predictor of overall antibiotic prescribing volume, B = -0.009 (95% confidence intervals, -0.012, -0.005), p < 0.001. GP training practices prescribed fewer antibiotics, representing a reduction of 6.2 centiles from the median. GP training practice status was also a significant predictor of broad spectrum antibiotic prescribing, B = -0.3 (95% confidence intervals, -0.04, -0.01), p = 0.001. GP training practices prescribed fewer broad spectrum antibiotics, representing a reduction from the median of 6.0 centiles. Discussion: Training practices prescribe fewer antimicrobials overall and specifically fewer broad spectrum oral antimicrobials (quinolones and cephalosporins). There is a need for further research to understand the interplay between postgraduate GP training and reductions in antimicrobial prescribing. What is already known about this area There is an emergent body of evidence that suggests training practice status is associated with better clinical outcomes. What this work adds Training practices, on average, prescribe fewer oral antibiotics overall, and specifically, fewer broad-spectrum oral antibiotics. Suggestions for future work There is a need for qualitative work to develop an understanding of how and why training practices are associated with improved clinical outcomes.