Evidence map›Paper›PMID 32665235›Full record

ArticleBJGP open2020

Investigating the mechanism of impact and differential effect of the Quality Premium scheme on antibiotic prescribing in England: a longitudinal study.

Philip Emeka Anyanwu, Koen Pouwels, Anne Walker, Michael Moore, Azeem Majeed, Benedict W J Hayhoe, Sarah Tonkin-Crine, Aleksandra Borek, Susan Hopkins, Monsey Mcleod and 1 more

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Article in BJGP open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Philip Emeka AnyanwuDepartment of Primary Care and Public Health, Imperial College London, London, UK anyanwuphilipemeka@gmail.com.ORCID http://orcid.org/0000-0003-2104-7062
Koen PouwelsNuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK.
Anne WalkerNuffield Department of Medicine, University of Oxford, Oxford, UK.
Michael MoorePrimary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK.
Azeem MajeedDepartment of Primary Care and Public Health, Imperial College London, London, UK.
Benedict W J HayhoePrimary Care and Public Health, Imperial College London School of Public Health, London, UK.ORCID http://orcid.org/0000-0002-2645-6191
Sarah Tonkin-CrineNational Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK.
Aleksandra BorekNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Susan HopkinsHealthcare-Associated Infection and Antimicrobial Resistance Department, National Infection Service, Public Health England, London, UK.
Monsey McleodPharmacy Department, Centre for Medication Safety and Service Quality, Imperial College London, London, UK.
Céire CostelloeDepartment of Primary Care and Public Health, Imperial College London, London, UK.

Funding

Department of Health CDF-2016-09-015
6 · The paper itself

Abstract

backgroundIn 2017, approximately 73% of antibiotics in England were prescribed from primary care practices. It has been estimated that 9%-23% of antibiotic prescriptions between 2013 and 2015 were inappropriate. Reducing antibiotic prescribing in primary care was included as one of the national priorities in a financial incentive scheme in 2015-2016.

aimTo investigate whether the effects of the Quality Premium (QP), which provided performance-related financial incentives to clinical commissioning groups (CCGs), could be explained by practice characteristics that contribute to variations in antibiotic prescribing. DESIGN &

settingLongitudinal monthly prescribing data were analysed for 6251 primary care practices in England from April 2014 to March 2016.

methodLinear generalised estimating equations models were fitted, examining the effect of the 2015-2016 QP on the number of antibiotic items per specific therapeutic group age-sex related prescribing unit (STAR-PU) prescribed, adjusting for seasonality and months since implementation. Consistency of effects after further adjustment for variations in practice characteristics were also examined, including practice workforce, comorbidities prevalence, prescribing rates of non-antibiotic drugs, and deprivation.

resultsAntibiotics prescribed in primary care practices in England reduced by -0.172 items per STAR-PU (95% confidence interval [CI] = -0.180 to -0.171) after 2015-2016 QP implementation, with slight increases in the months following April 2015 (+0.014 items per STAR-PU; 95% CI = +0.013 to +0.014). Adjusting the model for practice characteristics, the immediate and month-on-month effects following implementation remained consistent, with slight attenuation in immediate reduction from -0.172 to -0.166 items per STAR-PU. In subgroup analysis, the QP effect was significantly greater among the top 20% prescribing practices (interaction

conclusionIn high-prescribing practices, those with low workforce and high diabetes prevalence had more reduction following the QP compared with other practices, highlighting the need for targeted support of these practices and appropriate resourcing of primary care.

Indexed as

anti-bacterial agentsfinancial incentivegeneral practiceprimary health carequality premiumresistance

Identifiers

PMID32665235
PMCPMC7465585

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.