We read the study by Colin P Bradley et al1 regarding the influence of patient payment on antibiotic prescribing in Irish general practice. The Republic of Ireland is one of three European countries in which antibiotic use in general practice is increasing.1 Eligibility for Ireland's primary care services is determined by a means test with General Medical Service (GMS) card holders having access to GP services and medications free of charge. The remainder are private patients who pay a fee to access GP services.
We retrospectively reviewed a 2-week period in September 2011 in a practice with predominantly children and young patients presenting with symptoms that indicated a probable RTI (as in the Bradley et al study). The results were presented to the practice GPs and nurse in October and then a second 2-week period in December 2011 was then reviewed. Our results are shown in the table below.
Table Comparison of consultations for September and December 2011
The representation of GMS and private patients in September and December was approximately equal. Our findings show that there were more RTI presentations in December with less antibiotic prescribing overall, fewer antibiotics were prescribed to private patients in December, and higher use of delayed antibiotic prescribing.
As stated in many articles including the Bradley study, there are many external non-clinical factors that influence GPs prescribing such as patient's expectations, time constraints, patient volume, and mode of renumeration.1,2,3,4 Our brief audit demonstrates that doctors' behaviour can be changed by the use of data on their prescribing activities. The only intervention between September and December was a presentation of September's results to the clinical staff. Whether this will be sustained or not will be the subject of another audit.
- © British Journal of General Practice 2012
