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Research

Relationship between prescribing of antibiotics and other medicines in primary care: a cross-sectional study

Yan Li, Anna Mölter, Andrew White, William Welfare, Victoria Palin, Miguel Belmonte, Darren M Ashcroft, Matthew Sperrin and Tjeerd Pieter van Staa
Br J Gen Pract 2019; 69 (678): e42-e51. DOI: https://doi.org/10.3399/bjgp18X700457
Yan Li
Health e-Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
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Anna Mölter
Health e-Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
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Andrew White
NHS Greater Manchester Shared Service, Oldham, UK.
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William Welfare
Public Health England North West, Manchester, UK.
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Victoria Palin
Health e-Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
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Miguel Belmonte
Health e-Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
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Darren M Ashcroft
Centre for Pharmacoepidemiology and Drug Safety, and NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
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Matthew Sperrin
Health e-Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
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Tjeerd Pieter van Staa
Health e-Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK, and Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands.
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Figures

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  • Figure 1.
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    Figure 1.

    Associations between rates of prescribing of antibiotics and other medicines in general practices. CPRD = Clinical Practice Research Datalink. DPPD = digital practice prescribing data.

  • Figure 2.
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    Figure 2.

    Associations between rates of prescribing of antibiotics and non-opioid painkillers in general practices.

    CPRD = Clinical Practice Research Datalink. DPPD = digital practice prescribing data.

  • Figure 3.
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    Figure 3.

    Associations between rates of prescribing of antibiotics and benzodiazepines in general practices. CPRD = Clinical Practice Research Datalink. DPPD = digital practice prescribing data.

Tables

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    Table 1.

    Baseline characteristics of NHS-DPPD and CPRD practices

    Baseline characteristics of practicesNHS-DPPD (n= 6517)CPRD (n= 587)
    List per full-time equivalent GP, mean (SD)2306.2 (12114.0)n/aa
    Percentage of patients in London5.712.8
    Percentage of patients in North of England49.754.3
    Percentage of patients in South of England44.632.9
    Practice list size, mean (SD)7558.0 (4194.8)7732.2 (3516.3)
    Index of Multiple Deprivation 2015 score, mean (SD)25.9 (17.4)n/aa
    Adult skills sub-domain deprivation score, mean (SD)0.3 (0.1)n/aa
    Health deprivation and disability score, mean (SD)0.2 (0.9)n/aa
    Percentage of female patients, mean (SD)50.0 (2.2)58.1 (2.1)
    Rate of prescribing of other medicines, mean (SD)b17 631.3 (5707.8)16 587.3 (5923.6)
    Rate of prescribing of antibiotics, mean (SD)b576.1 (148.1)578.9 (177.4)
    Rate of prescribing of non-opioid painkillers, mean (SD)b1211.4 (544.4)1365.7 (611.3)
    Rate of prescribing of benzodiazepines, mean (SD)b274.8 (162.4)325.1 (247.1)
    • ↵a n/a means the dataset does not have the variable.

    • ↵b Rate per 1000 patients per year. CPRD = Clinical Practice Research Datalink. DPPD = digital practice prescribing data. n/a = not applicable. SD = standard deviation.

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    Table 2.

    Associations of prescribing of antibiotics with that of other medicines, non-opioid painkillers, and benzodiazepines

    Risk factorMean (SD)5thPercentile of risk factorsChange in risk factorRate of antibioticsRate of antibiotics% Increase in antibiotic for 5th–95thc
    25th75th95thIQR5th–95thChange per IQR,b crude (95% CI)Change per IQR, adjusted (95% CI)Change per 5th–95th percentile,b crude (95% CI)Change per 5th–95th percentile,b adjusted (95% CI)CrudeAdjusted
    Antibioticsa
    NHS-DPPD576.1 (148.1)329.9486.9666.8808.7179.9478.8n/an/an/an/an/an/a
    CPRD578.9 (177.4)268.0488.1688.5852.4200.4584.4n/an/an/an/an/an/a
    Other medicinesa
    NHS-DPPD17 631.3 (5707.8)8815.913 588.021 411.627 159.87823.618 343.9141.8 (138.3 to 145.3)117.8 (113.2 to 122.5)332.5 (324.4 to 340.7)276.3 (265.4 to 287.2)8060
    CPRD16 587.3 (5923.6)6909.812 732.620 399.025 966.77666.419 056.8167.5 (152.2 to 182.9)162.8 (148.4 to 177.3)416.4 (378.3 to 454.5)404.8 (368.9 to 440.6)100100
    Non-opioid painkillersa
    NHS-DPPD1211.4 (544.4)462.9809.61531.32215.6721.71752.7128.5 (124.8 to 132.2)119.7 (114.5 to 124.9)312.0 (303.1 to 321.0)290.7 (278.0 to 303.4)7060
    CPRD1365.7 (611.3)463.4895.01757.82344.3862.81880.9189.5 (173.0 to 206.0)189.0 (172.1 to 206.0)413.1 (377.0 to 449.1)412.1 (375.3 to 449.0)100100
    Benzodiazepinesa
    NHS-DPPD274.8 (162.4)79.7167.8344.3567.3176.5487.690.7 (87.0 to 94.5)62.4 (58.9 to 66.0)250.6 (240.4 to 260.9)172.4 (162.6 to 182.2)5030
    CPRD325.1 (247.1)81.2180.0381.0774.9201.0693.7 (87.0 to 110.5)98.7 (81.1 to 104.4)92.7 (300.1 to 381.2)340.7 (279.8 to 360.1)320.06050
    • ↵a Per 1000 patients per year.

    • ↵b Change in rate of antibiotic prescribing over IQR or 5th to 95th percentile of risk factor (other medicines, painkillers, or benzodiazepines).

    • ↵c % Increase in antibiotic for 5th–95% was calculated using Poisson model. CPRD = Clinical Practice Research Datalink. DPPD = digital practice prescribing data. n/a = not applicable. IQR = interquartile range.

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    Table 3.

    Analysis of relative importance of continuous risk factors for antibiotic prescribing

    Risk factorsChange in rate of antibiotics (95% CI)a over 5th to 95th percentiles in risk factorb
    NHS-DPPD
    Rate of prescribing of other medicines276.3 (265.4 to 287.2)
    Adult skills sub-domain score in practice area74.2 (57.8 to 90.5)
    % Male patients aged 0–4 years in practice48.5 (32.4 to 64.6)
    % Female patients aged 80–85 years in practice41.2 (29.4 to 52.9)
    Practice score in overall experience of making an appointment: not good28.7 (14.0 to 43.4)
    Health deprivation and disability score in practice area23.5 (5.3 to 41.8)
    % Male patients aged 5–9 years in practice25.0 (9.0 to 40.9)
    % Patients in practice with arthritis or long-term joint problem20.3 (9.1 to 31.5)
    % Female patients aged 45–49 years in practice21.5 (9.6 to 33.5)
    Crime score in practice area16.0 (3.8 to 28.2)
    % Male patients aged 55–59 years in practice16.9 (2.5 to 31.2)
    Medical conditions — % none of these conditions13.9 (1.1 to 26.6)
    % Patients in practice with another long-term condition11.5 (2.5 to 20.6)
    QOF asthma achievement, %−5.8 (−10.6 to −1.0)
    Practice score in rating of GP involving patients in decisions about care: % good−12.8 (−21.2 to −4.3)
    Indoors sub-domain score in practice area−13.4 (−22.2 to −4.5)
    Outdoors sub-domain score in practice area−16.2 (−28.6 to −3.9)
    Practice score in last seen or spoke to a GP: over the past 3 months−17.3 (−26.0 to −8.6)
    Practice score in confidence and trust in GP: % no, not at all−22.2 (−32.8 to −11.6)
    % Male patients aged 40−44 years in practice−25.1 (−35.8 to −14.4)
    Practice score of last time wanted to see GP or nurse: not seen GP at surgery−23.3 (−31.5 to −15.0)
    Practice score of overall experience of GP surgery: not good−24.9 (−41.1 to −8.7)
    Income deprivation score in practice area affecting older people−42.5 (−58.6 to −26.4)
    Employment score in practice area−51.5 (−71.3 to −31.8)
    CPRD
    Rate of prescribing of other medicines404.8 (368.9 to 440.6)
    Rate of consultations for upper respiratory tract infections43.8 (9.3 to 78.3)
    % Patients in practice who are smokers−41.9 (−79.3 to −4.5)
    Duration of GP visit, mean−60.9 (−95.9 to −25.8)
    % Patients in practice with higher Charlson comorbidity index−71.7 (−108.3 to −35.2)
    • ↵a Per 1000 patients per year.

    • ↵b Change in rate of antibiotic prescribing comparing practices in lower (5th) with higher percentiles (95th) of the risk factor. CPRD = Clinical Practice Research Datalink. DPPD = digital practice prescribing data. QOF = Quality and Outcomes Framework.

    • View popup
    Table 4.

    Explorative analyses of medication classes that are correlated with antibiotic prescribinga

    Risk factor — type of medicines (BNF category)Change in rate of antibiotics (95% CI)b over 5th to 95th percentiles in risk factorc
    NHS-DPPD, crude (95% CI)CPRD, crude (95% CI)
    Proton pump inhibitors (1.3.5)316.0 (307.5 to 324.5)406.1 (365.4 to 446.8)
    Renin–angiotensin system drugs (2.5.5)287.1 (277.7 to 296.5)312.7 (263.2 to 362.3)
    Antiplatelet drugs (2.9)283.2 (273.9 to 292.6)346.4 (300.1 to 392.7)
    Drugs used in nausea and vertigo (4.6)335.6 (326.7 to 344.5)258.9 (220.8 to 297.0)
    Selective serotonin reuptake inhibitors (4.3.3)332.6 (323.7 to 341.4)402.7 (363.2 to 442.2)
    Corticosteroids (respiratory) (3.2)323.4 (314.3 to 332.5)263.2 (214.4 to 311.9)
    Antispasmodic and other drugs altering gut motility (1.2)301.3 (291.4 to 311.2)299.0 (253.8 to 344.1)
    Glucocorticoid therapy (6.3.2)322.0 (312.8 to 331.3)158.3 (110.5 to 206.1)
    Beta-adrenoceptor blocking drugs (2.4)301.1 (292.1 to 310.1)363.0 (317.5 to 408.5)
    Lipid-regulating drugs (2.12)287.9 (278.6 to 297.1)189.2 (138.7 to 239.7)
    • ↵a Table shows the top 10 largest associations in NHS-DPPD, with corresponding results in CPRD.

    • ↵b Per 1000 patients per year.

    • ↵c Change in rate of antibiotic prescribing comparing practices in lower (5th) with higher (95th) percentiles of the risk factor. BNF = British National Formulary. CPRD = Clinical Practice Research Datalink. DPPD = digital practice prescribing data. IQR = interquartile range.

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British Journal of General Practice: 69 (678)
Br J Gen Pract
Vol. 69, Issue 678
January 2019
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Relationship between prescribing of antibiotics and other medicines in primary care: a cross-sectional study
Yan Li, Anna Mölter, Andrew White, William Welfare, Victoria Palin, Miguel Belmonte, Darren M Ashcroft, Matthew Sperrin, Tjeerd Pieter van Staa
Br J Gen Pract 2019; 69 (678): e42-e51. DOI: 10.3399/bjgp18X700457

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Relationship between prescribing of antibiotics and other medicines in primary care: a cross-sectional study
Yan Li, Anna Mölter, Andrew White, William Welfare, Victoria Palin, Miguel Belmonte, Darren M Ashcroft, Matthew Sperrin, Tjeerd Pieter van Staa
Br J Gen Pract 2019; 69 (678): e42-e51. DOI: 10.3399/bjgp18X700457
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Keywords

  • antibiotics
  • benzodiazepines
  • drug prescribing
  • general practice
  • non-antibiotics
  • non-opioid painkillers

More in this TOC Section

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  • Management of depression and referral of older people to psychological therapies: a systematic review of qualitative studies
  • Efficiency versus thoroughness in medication review: a qualitative interview study in UK primary care
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