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Antibiotic prescribing patterns of general practice registrars for infective conjunctivitis: a cross-sectional
Marcus D Cherry1, Amanda Tapley2, Debbie Quain2
1University of Newcastle, School of Medicine and Public Health, Faculty of Health and Medicine, Callaghan, New South Wales, Australia.
Abstract:
INTRODUCTION Over-prescription of antibiotics for common infective conditions is an important health issue. Infective conjunctivitis represents one of the most common eye-related complaints in general practice. Despite its self-limiting nature, there is evidence of frequent general practitioner (GP) antibiotic prescribing for this condition, which is inconsistent with evidence-based guidelines. AIM To investigate the prevalence and associations of GP registrars' (trainees') prescription of antibiotics for infective conjunctivitis. METHODS We performed a cross-sectional analysis of the Registrar Encounters in Clinical Training (ReCEnT) ongoing prospective cohort study, which documents GP registrars' clinical consultations (involving collection of information from 60 consecutive consultations, at three points during registrar training). The outcome of the analyses was antibiotic prescription for a new diagnosis of conjunctivitis. Patient, registrar, practice and consultation variables were included in uni- and multivariable logistic regression analyses to test associations of these prescriptions. RESULTS In total, 2333 registrars participated in 18 data collection rounds from 2010 to 2018. There were 1580 new cases of infective conjunctivitis (0.31% of all problems). Antibiotics (mainly topical) were prescribed in 1170 (74%) of these cases. Variables associated with antibiotic prescription included patients' Aboriginal or Torres Strait Islander status, registrar organisation of a follow up (both registrar and other GP follow up), and earlier registrar training term (more junior status). DISCUSSION GP registrars, like established GPs, prescribe antibiotics for conjunctivitis in excess of guideline recommendations, but prescribing rates are lower in later training. These prescribing patterns have educational, social and economic consequences. Further educational strategies may enhance attenuation of registrars' prescribing during training.
Insights
General practitioners (GPs) frequently over-prescribe antibiotics for infective conjunctivitis, a common eye condition. Prescribing rates decrease as GP registrars gain more training, suggesting educational interventions can improve antibiotic stewardship.
Area of Science:
- General Practice
- Ophthalmology
- Pharmacology
Background:
- Antibiotic over-prescription for common infections is a significant health concern.
- Infective conjunctivitis is a frequent complaint in general practice, often self-limiting.
- Current antibiotic prescribing for conjunctivitis frequently deviates from evidence-based guidelines.
Purpose of the Study:
- To determine the frequency of antibiotic prescriptions for infective conjunctivitis by GP registrars.
- To identify factors associated with antibiotic prescribing for this condition among GP registrars.
Main Methods:
- Cross-sectional analysis of the Registrar Encounters in Clinical Training (ReCEnT) cohort study.
- Inclusion of 1580 new cases of infective conjunctivitis from 2333 GP registrars between 2010 and 2018.
- Logistic regression analyses to identify associations between patient, registrar, practice, and consultation variables and antibiotic prescription.
Main Results:
- Antibiotics were prescribed in 74% of infective conjunctivitis cases.
- Prescribing was associated with patients' Indigenous status, the organization of follow-up care, and registrar's training stage (more junior registrars prescribed more).
- Antibiotic prescribing rates decreased in later stages of registrar training.
Conclusions:
- GP registrars, similar to established GPs, exceed recommended antibiotic prescribing rates for conjunctivitis.
- Educational strategies targeting GP registrars may help reduce inappropriate antibiotic use.
- Addressing prescribing variations is crucial for improving antibiotic stewardship and patient outcomes.
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