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Financial incentives help cut antibiotic prescribing

Scheme has led to 3% drop in GP prescribing of antibiotics

Adrian O'Dowd

Thursday, 28 June 2018

A national incentive scheme has helped to reduce unnecessary prescribing of antibiotics by GPs, according to a study* published in the Journal of Antimicrobial Chemotherapy.

Researchers from Imperial College London and Public Health England (PHE) found the number of patients prescribed antibiotics by their GP for a common respiratory infection fell significantly following the introduction of potential rewards within the NHS England Quality Premium scheme in 2015-16.

The scheme was introduced to reward CCGs for improving their services and offers financial incentives to CCGs for meeting a number of criteria.

In 2015 to 2016, this included measures to reduce total antibiotic prescribing by 1%, as well as 10% reduction in prescriptions for broad spectrum antibiotics, used to tackle a range of bacterial infections.

In England, respiratory tract infections (RTIs) are one of the most common reasons for a visit to the GP, with many patients being prescribed antibiotics and there has been a drive to cut their use to avoid growing rates of antimicrobial resistance.

Researchers set out to assess the impact of the Quality Premium on the rate of antibiotic prescribing and reviewed data from general practices across England, focusing on prescribing of antibiotics for uncomplicated RTIs from 2011 to 2017.

Their analysis revealed that apart from expected seasonal peaks and troughs, prescribing rates decreased over the six-year study period and there was a 3% drop in the rate of antibiotic prescribing in April 2015, coinciding with the introduction of the Quality Premium reward.

This reduction was sustained, such that after two years, there was a 3% decrease in prescribing relative to that expected had the pre-intervention trend continued.

The analysis also showed reductions in the rate of prescriptions for broad spectrum antibiotics for RTIs.

The greatest reductions in antibiotic prescribing were seen for patients with sore throats, as well as in younger patients, with a 6% reduction in prescribing for children two years after the introduction of the intervention.

Sabine Bou-Antoun, an epidemiologist and research postgraduate at the School of Public Health at Imperial and first author of the study: “It is important to reduce unnecessary and inappropriate antibiotic prescribing as it is a known driver of antibiotic resistance.

“It’s also important to measure the impact of national interventions targeted at improving the use of antibiotics so we can evaluate and identify what is working.”

Professor Alan Johnson, from the PHE Centre for Infectious Disease Surveillance and Control, said: “As part of a national strategy to tackle antibiotic resistance, this is one of a range of successful interventions used to support GPs to reduce levels of prescribing. It is important that we continue to reduce the levels of inappropriate prescribing if we are to prevent further increases in drug-resistant infections.”

According to the researchers, further research is currently being undertaken to follow up on the findings to establish whether reductions in antibiotic prescribing in primary care is associated with any negative impacts, including increased illness.


*Bou-Antoun, S, et al. Age-related decline in antibiotic prescribing for uncomplicated respiratory tract infections in primary care in England following the introduction of a national financial incentive (the Quality Premium) for health commissioners to reduce use of antibiotics in the community: an interrupted time series analysis. Journal of Antimicrobial Chemotherapy. DOI: 10.1093/jac/dky237

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