Please use this identifier to cite or link to this item: http://docs.prosentient.com.au/prosentientjspui/handle/1/10453
Title: Changes in early-career family physicians' antibiotic prescribing for upper respiratory tract infection and acute bronchitis: a multicentre longitudinal study.
Authors: Magin, Parker J
Morgan, Simon
Tapley, Amanda
Henderson, Kim M
Holliday, Elizabeth G
Ball, Jean
Davis, Joshua S
Dallas, Anthea
Davey, Andrew R
Spike, Neil A
McArthur, Lawrie
Stewart, Rebecca
Mulquiney, Katie J
van Driel, Mieke L
Affiliation: School of Medicine and Public Health, University of Newcastle, Callaghan, NSW General Practice Training-Valley to Coast, Mayfield, NSW parker.magin@newcastle.edu.au..
General Practice Training-Valley to Coast, Mayfield, NSW..
General Practice Training-Valley to Coast, Mayfield, NSW..
General Practice Training-Valley to Coast, Mayfield, NSW..
Hunter Medical Research Institute, CReDITTS, New Lambton Heights, NSW..
Hunter Medical Research Institute, CReDITTS, New Lambton Heights, NSW..
School of Medicine and Public Health, University of Newcastle, Callaghan, NSW Menzies School of Health Research, Royal Darwin Hospital Campus, Casuarina, NT John Hunter Hospital, New Lambton Heights, NSW..
Discipline of General Practice, University of Queensland, Brisbane, QLD..
School of Medicine and Public Health, University of Newcastle, Callaghan, NSW..
Victorian Metropolitan Alliance General Practice Training, Hawthorn, VIC Department of General Practice, University of Melbourne, Carlton, VIC..
Adelaide to Outback GP Training Program, North Adelaide, SA and..
Tropical Medical Training, Townsville, QLD Australia..
General Practice Training-Valley to Coast, Mayfield, NSW..
Discipline of General Practice, University of Queensland, Brisbane, QLD..
Issue Date: 2016
Citation: Family practice 2016; 33(4): 360-7
Abstract: Inappropriate antibiotic prescription and subsequent antibacterial resistance are major threats to health worldwide. 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. 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'. 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). 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.
URI: http://docs.prosentient.com.au/prosentientjspui/handle/1/10453
DOI: 10.1093/fampra/cmw025
Type: Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Subjects: Antibacterial agents
family practice
general practice
inappropriate prescribing
physician practice patterns
respiratory tract infections.
Acute Disease
Adult
Anti-Bacterial Agents
Australia
Bronchitis
Female
Humans
Inappropriate Prescribing
Logistic Models
Longitudinal Studies
Male
Multivariate Analysis
Odds Ratio
Physicians, Family
Practice Patterns, Physicians'
Referral and Consultation
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