Antibiotic prescribing patterns of general practice registrars for infective conjunctivitis: a cross-sectional analysis
Marcus D. Cherry 1 , Amanda Tapley 1 2 , Debbie Quain 1 2 , Elizabeth G. Holliday 1 , Jean Ball 3 , Andrew Davey 1 2 , Mieke L. van Driel 4 , Alison Fielding 1 2 , Neil Spike 5 6 , Kristen FitzGerald 7 , Parker Magin 1 2 81 University of Newcastle, School of Medicine and Public Health, Faculty of Health and Medicine, Callaghan, New South Wales, Australia.
2 GP Synergy, General Practice Regional Training Organisation, NSW and ACT Research and Evaluation Unit, Newcastle, New South Wales, Australia.
3 Hunter Medical Research Institute, Clinical Research Design IT and Statistical Support Unit, New Castle, NSW, Australia
4 The University of Queensland, Primary Care Clinical Unit, Faculty of Medicine, Brisbane, Queensland, Australia.
5 Eastern Victoria General Practice Training, Melbourne, Victoria, Australia.
6 Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia.
7 General Practice Training Tasmania, Hobart, Tasmania, Australia.
8 Corresponding author. Email: parker.magin@newcastle.edu.au
Journal of Primary Health Care 13(1) 5-14 https://doi.org/10.1071/HC20040
Published: 8 March 2021
Journal Compilation © Royal New Zealand College of General Practitioners 2021 This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License
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.
KEYwords: Epidemiology; general practice; conjunctivitis; antibiotic stewardship; medical education
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