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- Page navigation anchor for Locums and antibiotic prescribing – Author response to Dr Arnold ZermanskyLocums and antibiotic prescribing – Author response to Dr Arnold Zermansky
We thank Dr Zermansky for their engagement with our paper. The qualitative part of this mixed-methods study explored influences on antibiotic prescribing and potential reasons for any differences in patterns of prescribing; so, we agree with Dr Zermansky regarding the complexity of antibiotic prescribing decisions and the many different factors affecting decisions.
The purpose of the quantitative analysis was to describe patterns of prescribing for which the retrospective design is appropriate. It does not focus on mechanisms underlying the observed patterns, such as differences in patient-mix. As highlighted in our article, the quantitative analysis focused on patients without relevant comorbidities, and excluded recurrent, chronic, and complicated (e.g. bilateral otitis media) presentations, but this does not guarantee that some of the (absence of) differences are explained by other differences in case-mix seen by nurse prescribers, locums, and other general practitioners.
We did not explore patterns of prescribing across different days of the week, but previous analyses have shown little difference (see supplementary Tables S1-S2 in Pouwels et al. 2018, https://doi.org/10.1093/jac/dkx502). We accept that our study analysed prescribing data up to 2015 (the dataset which we had access to at the time of the analysis), which we acknowledge as a limitation in the paper.
We disagree wit...
Show MoreCompeting Interests: None declared. - Page navigation anchor for Locums and antibiotic prescribingLocums and antibiotic prescribing
Borek et al’s quantitative study of locum GPs’ prescribing of antibiotics compared with other prescribers in general practice published over six years after the events studied is seriously flawed both in the design of the study and in the authors’ interpretation of the outcome.1
The retrospective study design is flawed because there can be no randomisation of patients to either locum or non-locum consultation. The implied premise is that patients who attend locums and emerge with a particular diagnosis are exactly comparable with those attending others with the same diagnosis, and that the proportion of patients for whom antibiotics are appropriate is the same for both groups.
Patients often exercise choice in their booking of appointments. Many elect for continuity and seek an appointment with their regular doctor. Those whose symptoms are most severe may settle for an appointment with whoever is available soonest, which may be more likely to be a locum. It is therefore inappropriate to assume that the severity of the illness, the patients’ level of risk, the exact nature of the illness in patients with the same diagnostic label, or its likelihood of responding to an antibiotic is equivalent in both groups.
The authors then go on to muddle statistical significance with clinical significance. I believe that the same prescriber (me, for instance) with similar patients actually prescribes in a statistically different...
Show MoreCompeting Interests: None declared.