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Reducing Unnecessary Antibiotics Prescriptions by GPs Through Online Decision Support

Unnecessary prescriptions of antibiotics for respiratory illness can be reduced through electronically delivered prescribing feedback and online decision support for GPs, reports a new study at King’s College London. The study was published in The BMJ on February 12th, 2019.

NHS prescribing data indicate that every month, GPs in the United Kingdom prescribe roughly 1.8 million antibiotic courses for the treatment of respiratory infections such as colds, coughs, bronchitis, sinusitis, otitis media, and sore throat, which cost about £9 million. At present, antimicrobial-resistant infections claim about 50,000 lives every year across Europe and the United States, and the figures stand at 700,000 worldwide. These numbers are set to increase to a predicted 10 million deaths every year by 2050, which would represent a higher death toll compared to diabetes and cancer combined.

The researchers from the School of Population Health & Environmental Sciences of King’s College London carried out a year-long trial, including 79 general practices across the United Kingdom. A short training webinar, monthly feedback reports of their antibiotic prescriptions for respiratory illness, and online access to decision support materials were given to the GPs in the intervention trial arm. The trial scrutinized the anonymized electronic health records of over 500,000 patients.

Results demonstrated that antibiotic prescribing was decreased by 12% on the whole, where there was a decrease of one antibiotic prescription for every 62 patients in the age group of 15–85 years. No evidence of an increase in severe bacterial complications, including scarlet fever or pneumonia, was found. There was no reduction in the antibiotic prescribing of GPs to older adults (85 years and older) or to children (under 15 years). According to the authors, further evaluation of the antibiotic prescribing in these groups is necessary.

Decision support tools ranged from information leaflets for patients and carers on the anticipated duration of symptoms, self-care recommendations, to guidance on the timeframe by which to seek assistance again if necessary. They also prompted GPs when and when not to prescribe antibiotics.

Misuse of antibiotics is putting us all at risk. Taking antibiotics when they are not needed is leading to the emergence of resistant infections that can be very difficult to treat. This trial showed that providing GPs with information about their use of antibiotics for respiratory illnesses led to a reduction in antibiotic use. If this approach is scaled up nationally, it could contribute to reducing the emergence of antibiotic resistance.

Martin Gulliford, Professor of Public Health, King’s College London.

Gulliford is also the lead author of the study.

The trial was carried out with the help of the anonymized electronic health records of general practices contributing to the UK Clinical Practice Research Datalink (CPRD). The National Institute for Health Research (NIHR) Health Technology Assessment Programme funded the trial.

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