Antibiotic prescribing for respiratory infections: a cross-sectional analysis of the ReCEnT study exploring the habits of early-career doctors in primary care

Abstract

Background: Antibiotic resistance is among the most important current public health issues. Most antibiotics are prescribed in primary care. There is strong consensus that they are overprescribed, especially for conditions such as upper respiratory tract infections (URTI) and acute bronchitis, where they provide limited benefit. Interventions to alter prescribing patterns have shown limited effect. Trainees in family practice may be an appropriate target, as their prescribing habits are still developing.

Objective: To establish prevalence and associations of trainee prescribing of antibiotics for URTI and acute bronchitis/bronchiolitis.

Methods: A cross-sectional analysis of the Registrar Clinical Encounters in Training (ReCEnT) study. ReCEnT is an ongoing cohort study of Australian General Practice (GP) trainees documenting the nature of their consultation-based clinical experiences. Trainees record details of 60 consecutive patient encounters every 6-month training term. Univariate and logistic regression analyses were conducted on data recorded in consultations related to URTI and acute bronchitis/bronchiolitis in six collection periods during 2010-12.

Results: Data from 401 trainees (94.7% response rate) were analysed. Antibiotics were prescribed in 21.6% of encounters for URTI and 73.1% of encounters for acute bronchitis/bronchiolitis. Trainees prescribing antibiotics were more likely to order tests, and to seek in-consultation advice. Logistic regression analysis demonstrated older patient age, Indigenous patient background, and practices in higher socioeconomic areas were significant predictors of antibiotic prescribing.

Conclusion: GP trainee antibiotic prescribing is higher than justified by guidelines. Understanding factors contributing to this pattern will assist in developing educational interventions to improve evidence-based prescribing habits during the early stages of these doctors' careers.

Keywords: Antibacterial agents; drug resistance; evidence-based medicine; general practice; graduate medical education; microbial; physician prescribing patterns..