Delayed Antibiotic Prescription by General Practitioners in the UK: A Stated-Choice Study

Liz Morrell; James Buchanan; Laurence S J Roope; Koen B Pouwels; Christopher C Butler; Benedict Hayhoe; Michael V Moore; Sarah Tonkin-Crine; Monsey McLeod; Julie V Robotham; A Sarah Walker; Sarah Wordsworth; On Behalf Of The Stepup Team

doi:10.3390/antibiotics9090608

Delayed Antibiotic Prescription by General Practitioners in the UK: A Stated-Choice Study

Antibiotics (Basel). 2020 Sep 16;9(9):608. doi: 10.3390/antibiotics9090608.

Authors

Liz Morrell¹, James Buchanan^{1

2

3}, Laurence S J Roope^{1

2

3}, Koen B Pouwels^{1

2}, Christopher C Butler^{2

4}, Benedict Hayhoe⁵, Michael V Moore⁶, Sarah Tonkin-Crine^{2

4}, Monsey McLeod^{7

8

9}, Julie V Robotham¹⁰, A Sarah Walker^{2

3

11}, Sarah Wordsworth^{1

2

3}, On Behalf Of The Stepup Team

Affiliations

¹ Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK.
² NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford OX2 6GG, UK.
³ NIHR Biomedical Research Centre Oxford, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK.
⁴ Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
⁵ Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W2 1PG, UK.
⁶ Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK.
⁷ NIHR Health Protection Research Unit in Healthcare-Associated Infections and Antimicrobial Resistance, Imperial College London, London SW7 2AZ, UK.
⁸ Centre for Medication Safety and Service Quality, Pharmacy Department, Imperial College Healthcare NHS Trust, London W2 1NY, UK.
⁹ NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, London SW7 2AZ, UK.
¹⁰ Modelling and Economics Unit, National Infection Service, Public Health England, London SE1 8UG, UK.
¹¹ Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, UK.

Abstract

Delayed antibiotic prescription in primary care has been shown to reduce antibiotic consumption, without increasing risk of complications, yet is not widely used in the UK. We sought to quantify the relative importance of factors affecting the decision to give a delayed prescription, using a stated-choice survey among UK general practitioners. Respondents were asked whether they would provide a delayed or immediate prescription in fifteen hypothetical consultations, described by eight attributes. They were also asked if they would prefer not to prescribe antibiotics. The most important determinants of choice between immediate and delayed prescription were symptoms, duration of illness, and the presence of multiple comorbidities. Respondents were more likely to choose a delayed prescription if the patient preferred not to have antibiotics, but consultation length had little effect. When given the option, respondents chose not to prescribe antibiotics in 51% of cases, with delayed prescription chosen in 21%. Clinical features remained important. Patient preference did not affect the decision to give no antibiotics. We suggest that broader dissemination of the clinical evidence supporting use of delayed prescription for specific presentations may help increase appropriate use. Establishing patient preferences regarding antibiotics may help to overcome concerns about patient acceptance. Increasing consultation length appears unlikely to affect the use of delayed prescription.

Keywords: UK; antibiotic resistance; choice experiment; delayed prescription; general practice; primary care; respiratory tract infection; stewardship.

Abstract

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