ArticleThe Journal of antimicrobial chemotherapy2018
Explaining variation in antibiotic prescribing between general practices in the UK.
Article in The Journal of antimicrobial chemotherapy, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 48 papers, 1 of them a synthesis that pooled it.
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Who cites it
48 citing papers in PubMed, 1 synthesis or guideline pooled it, 84 citations in OpenAlex.
- Factors contributing to the variation in antibiotic prescribing among primary health care physicians: a systematic review.BMC primary care · 2024Pooled it
- Reducing expectations for antibiotics in primary care: a randomised experiment to test the response to fear-based messages about antimicrobial resistance.BMC medicine · 2020Trial
- Effectiveness and safety of electronically delivered prescribing feedback and decision support on antibiotic use for respiratory illness in primary care: REDUCE cluster randomised trial.BMJ (Clinical research ed.) · 2019Trial
- Which interventions optimize antibiotic prescribing in primary care in England? A survey and Qualitative Comparative Analysis of NHS Integrated Care Boards.JAC-antimicrobial resistance · 2025Article
- Article
- Prenatal maternal infections and early childhood developmental outcomes: analysis of linked administrative health data for Greater Glasgow & Clyde, Scotland.Journal of child psychology and psychiatry, and allied disciplines · 2025Article
- Article
- Clinical competence, communication ability and adherence to choosing wisely recommendations for lipid reducing drug use in older adults.BMC geriatrics · 2023Article
- Antibiotic prescribing in remote versus face-to-face consultations for acute respiratory infections in primary care in England: an observational study using target maximum likelihood estimation.EClinicalMedicine · 2023Article
- Hospitalizations and severe complications following acute sinusitis in general practice: a registry-based cohort study.The Journal of antimicrobial chemotherapy · 2023Article
- Physician antimicrobial prescribing and patient outcomes on general medical wards: a multicentre retrospective cohort study.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2023Article
- Profiles of GPs with high and low self-reported physician empathy-personal, professional, and antibiotic prescribing characteristics.BMC primary care · 2022Article
- Variation of GP antibiotic prescribing tendency for contacts with out-of-hours primary care in Denmark - a cross-sectional register-based study.Scandinavian journal of primary health care · 2022Article
- Outpatient Antibiotic Prescriptions in France: Patients and Providers Characteristics and Impact of the COVID-19 Pandemic.Antibiotics (Basel, Switzerland) · 2022Article
- Factors predicting amoxicillin prescribing in primary care among children: a cohort study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2022Article
- Role of locum GPs in antibiotic prescribing and stewardship: a mixed-methods study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2022Article
- Development and validation of antibiotic stewardship metrics for outpatient respiratory tract diagnoses and association of provider characteristics with inappropriate prescribing.Infection control and hospital epidemiology · 2022Article
- Descriptive analysis of adverse drug reaction reports for hypersensitivity reactions stratified in relation to different beta-lactam antibiotics.Allergologie select · 2022Article
- Empowering Patients to Self-Manage Common Infections: Qualitative Study Informing the Development of an Evidence-Based Patient Information Leaflet.Antibiotics (Basel, Switzerland) · 2021Article
- Public preferences for delayed or immediate antibiotic prescriptions in UK primary care: A choice experiment.PLoS medicine · 2021Article
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Objectives: Primary care practices in England differ in antibiotic prescribing rates, and, anecdotally, prescribers justify high prescribing rates based on their individual case mix. The aim of this paper was to explore to what extent factors such as patient comorbidities explain this variation in antibiotic prescribing. Methods: Primary care consultation and prescribing data recorded in The Health Improvement Network (THIN) database in 2013 were used. Boosted regression trees (BRTs) and negative binomial regression (NBR) models were used to evaluate associations between predictors and antibiotic prescribing rates. The following variables were considered as potential predictors: various infection-related consultation rates, proportions of patients with comorbidities, proportion of patients with inhaled/systemic corticosteroids or immunosuppressive drugs, and demographic traits. Results: The median antibiotic prescribing rate was 65.6 (IQR 57.4-74.0) per 100 registered patients among 348 English practices. In the BRT model, consultation rates had the largest total relative influence on antibiotic prescribing rate (53.5%), followed by steroid and immunosuppressive drugs (31.6%) and comorbidities (12.2%). Only 21% of the deviance could be explained by an NBR model considering only comorbidities and age and gender, whereas 57% of the deviance could be explained by the model considering all variables. Conclusions: The majority of practice-level variation in antibiotic prescribing cannot be explained by variation in prevalence of comorbidities. Factors such as high consultation rates for respiratory tract infections and high prescribing rates for corticosteroids could explain much of the variation, and as such may be considered in determining a practice's potential to reduce prescribing.
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