Elsevier

Public Health

Volume 120, Issue 8, August 2006, Pages 752-759
Public Health

Original Research
Reducing variation in antibacterial prescribing rates for ‘cough/cold’ and sore throat between 1993 and 2001: Regional analyses using the general practice research database

https://doi.org/10.1016/j.puhe.2006.02.007Get rights and content

Summary

Objective

To use the General Practice Research Database (GPRD) to explore the regional variation in prescribing for single diagnostic episodes of ‘cough/cold’ and sore throat and how this changed between 1993 and 2001.

Methods

Data from the GPRD was used to conduct a longitudinal survey of morbidity and antibiotic prescribing data.

Results

Nationally there has been a substantial reduction in diagnosed episodes per 1000 patient years at risk for both diagnoses: from 104.6 (104.0–105.2) to 86.5 (86.0–86.9) for cough/cold (−17.3%) and from 102.8 (102.2–103.4) to 69.2 (68.8–69.6) for sore throat (−32.6%). In addition to the changes in diagnostic rate there have been reductions in diagnosis-related prescribing: from 41.8% to 34.8% of cough/cold episodes (−7.0%) and from 77.3% to 60.8% of sore throat episodes (−16.4%). These aggregated data conceal wide regional variations. For cough/cold the change in prescribing rate during the study varied from −16.0% to +5.3% and for sore throat from −28.3% to −7.3%.

Conclusions

In addition to a substantial reduction in diagnosis of cough/cold and sore throat, there has been a reduction in diagnosis-related prescribing episodes in almost all regions. Although there continues to be regional variation in diagnosis-related prescribing this has reduced substantially over the 9-year study period.

Introduction

There have been several recent reports and initiatives stressing the importance of reducing inappropriate antimicrobial prescribing in order to reduce antimicrobial resistance.1, 2, 3 It is known that there has been a reduction in antimicrobial prescribing in primary care between 1995 and 2000.4 Two recent reports have also demonstrated a reduction in consultations for upper respiratory tract infections which is likely to have contributed to the decline in antimicrobial prescribing.4, 5

The NHS Executive responded to the House of Lords Select Committee on Science and Technology report by issuing a Health Services Circular, which detailed action for the NHS to minimize mortality and morbidity due to antimicrobial resistant infection and control antimicrobial resistant organisms.6, 7 Although general practitioners (GPs) and prescribing advisers use prescribing analysis and cost (PACT) data to monitor antibiotic prescribing in primary care at a local level, it is not possible to use PACT data to assess for which conditions the antibiotics were prescribed.8, 9 There is little information available on prescribing linked to morbidity other than at the national level. Successful implementation of prescribing change is usually based on local initiatives to improve practice at a local level.10, 11 Thus it is important that there is information on prescribing at a sub-national level to help with the assessment of progress with such local initiatives and to guide areas of priority.

In a previous study12 we used the General Practice Research Database (GPRD) to assess antibiotic prescribing at a national level for three of the recommendations made by the Standing Medical Advisory Committee on things that could be done to influence prescribing in the community (limit antimicrobial prescribing for coughs and colds and simple sore throats and limit prescribing for urinary tract infections to 3 days). It is important to explore these changes at a regional level in order that Strategic Health Authorities and devolved administrations are aware of antibacterial usage in their populations. We explored antibiotic prescribing linked to cough/cold and sore throat by regions in the UK.

Section snippets

Methods

The methods have been described in detail elsewhere.12 In summary we used the GPRD, which currently collects data from over 350 General Practices and on about 5% of the UK population. English practices contributing to the GPRD are assigned to areas covered by the former NHS Regions before they were replaced by Directorates of Health and Social Care in April 2002. Practices also contribute from Scotland, Wales and Northern Ireland. Diagnoses are recorded in the GPRD using either the Oxford

Episodes of cough/cold

The regional episode rates of cough/cold ranged from 152.3 (Northern Ireland) to 84.5 (London) per 1000 patient years at risk in 1993. Rates tended to be higher in the North (Table 1). The UK episode rates for cough/cold decreased by 17.3% between 1993 and 2001, rates for Northern Ireland decreasing by 50.0%, but South East rates increased by 5.4% (Table 1).

Between 1993 and 2001 the regional episode rates for cough/cold converged. For 2001 the variance of episode rates in all regions was

Discussion

Episode rates for cough/cold decreased by nearly a fifth in the UK between 1993 and 2001, but the change differed by region, decreasing by a half in Northern Ireland and increasing in the South East. Sore throat episode rates decreased by nearly a third in the UK between 1993 and 2001 (decreasing by over a half in Northern Ireland and by a quarter in the West Midlands). For both conditions there is a tendency for a higher rate in the North. The variance in episode rates between UK regions has

References (20)

  • C.A. McNulty

    Optimising antibiotic prescribing in primary care

    Int J Antimicrob Agents

    (2001)
  • UK Antimicrobial resistance strategy and action plan

    (2000)
  • The path of least resistance

    (1998)
  • M. Woodhead et al.

    Antibiotics, resistance and clinical outcomes

    BMJ

    (2004)
  • D.M. Fleming et al.

    The reducing incidence of respiratory tract infection and its relation to antibiotic prescribing

    Br J Gen Pract

    (2003)
  • M. Ashworth et al.

    Why has antibiotic prescribing for respiratory illness declined in primary care? A longitudinal study using the General Practice Research Database

    J Public Health (Oxford)

    (2004)
  • House of Lords Select Committee on Science and Technology. Resistance to antibiotics and other antimicrobial agents....
  • NHS Executive. Resistance to antibiotics and other antimicrobial agents. Health Service Circular 1999/049. London:...
  • A. Majeed et al.

    What can PACT data tell us about prescribing in general practice?

    BMJ

    (1997)
  • A. Hepburn

    The interpretation and use of PACT

    Prescr J

    (1991)
There are more references available in the full text version of this article.

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