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Diagnosis-linked antibiotic prescribing in Swedish primary care - a comparison between in-hours and out-of-hours
Olof Cronberg1,2,3, Mia Tyrstrup4,5, Kim Ekblom6,7
1Växjöhälsan Primary Healthcare Center, VC Växjöhälsan, Hjortvägen 1, 352 45, Växjö, Sweden. olof.cronberg@med.lu.se.
Background:
The rise in antibiotic resistance is a global public health concern, and antibiotic overuse needs to be reduced. Earlier studies of out-of-hours care have indicated that antibiotic prescribing is less appropriate than that of in-hours care. However, no study has compared the out-of-hours treatment of infections to in-hours treatment within the same population.
Methods:
This retrospective, descriptive study was based on data retrieved from the Kronoberg Infection Database in Primary Care (KIDPC), which consists of all visits to primary care with an infection diagnosis or prescription of antibiotics during 2006-2014. The purpose was to study the trends in antibiotic prescribing and to compare consultations and prescriptions between in-hours and out-of-hours.
Results:
The visit rate for all infections was 434 visits per 1000 inhabitants per year. The visit rate was stable during the study period, but the antibiotic prescribing rate decreased from 266 prescriptions per 1000 inhabitants in 2006 to 194 prescriptions in 2014 (mean annual change - 8.5 [95% CI - 11.9 to - 5.2]). For the out-of-hours visits (12% of the total visits), a similar reduction in antibiotic prescribing was seen. The decrease was most apparent among children and in respiratory tract infections. When antibiotic prescribing during out-of-hours was compared to in-hours, the unadjusted relative risk of antibiotic prescribing was 1.37 (95% CI 1.36 to 1.38), but when adjusted for age, sex, and diagnosis, the relative risk of antibiotic prescribing was 1.09 (95% CI 1.08 to 1.10). The reduction after adjustment was largely explained by a higher visit rate during out-of-hours for infections requiring antibiotics (acute otitis media, pharyngotonsillitis, and lower urinary tract infection). The choices of antibiotics used for common diagnoses were similar.
Conclusions:
Although the infection visit rate was unchanged over the study period, there was a significant reduction in antibiotic prescribing, especially to children and for respiratory tract infections. The higher antibiotic prescribing rate during out-of-hours was small when adjusted for age, sex, and diagnosis. No excess prescription of broad-spectrum antibiotics was seen. Therefore, interventions selectively aiming at out-of-hours centres seem to be unmotivated in a low-prescribing context.
Insights
Antibiotic prescribing decreased significantly, especially for children and respiratory infections. Out-of-hours antibiotic use was only slightly higher than in-hours after adjusting for patient factors, suggesting targeted interventions are unnecessary.
Area of Science:
- Infectious Diseases
- Public Health
- Primary Care Medicine
Background:
- Antibiotic resistance is a growing global health threat, necessitating reduced antibiotic overuse.
- Previous research suggests out-of-hours antibiotic prescribing may be less appropriate than in-hours care.
- This study addresses a gap by comparing out-of-hours and in-hours infection treatment within the same population.
Purpose of the Study:
- To analyze trends in antibiotic prescribing in primary care from 2006-2014.
- To compare antibiotic prescribing rates between in-hours and out-of-hours primary care visits.
- To evaluate the appropriateness of antibiotic use in different care settings.
Main Methods:
- Retrospective, descriptive study using the Kronoberg Infection Database in Primary Care (KIDPC).
- Data included all primary care visits for infections or antibiotic prescriptions between 2006 and 2014.
- Analysis focused on visit rates, prescribing trends, and comparative prescribing between in-hours and out-of-hours care.
Main Results:
- Overall infection visit rates remained stable, but antibiotic prescriptions decreased from 266 to 194 per 1000 inhabitants annually.
- A similar reduction in antibiotic prescribing was observed for out-of-hours visits.
- Adjusted analysis showed a small increase in out-of-hours antibiotic prescribing (RR 1.09), primarily due to higher rates of specific infections like acute otitis media.
Conclusions:
- Significant reductions in antibiotic prescribing were observed, particularly for pediatric and respiratory tract infections.
- The difference in antibiotic prescribing between out-of-hours and in-hours care was minimal after adjusting for key patient and diagnostic factors.
- Targeted interventions for out-of-hours centers are likely unwarranted in this low-prescribing context, as no excess use of broad-spectrum antibiotics was detected.
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