BackgroundAntibiotic prescribing is a major concern that contributes to the problem of antibiotic resistance.AimTo assess the effect on antibiotic prescribing in primary care of telehealth (TH) consultations compared to face-to-face (F2F).Design & settingSystematic review and meta-analysis of adult or paediatric patients with a history of a community acquired acute infection (respiratory, urinary, or skin and soft tissue). We included studies that compared synchronous TH consultations (phone or video based) to F2F consultations in primary care.MethodWe searched PubMed, Embase, Cochrane CENTRAL (inception-2021), clinical trial registries and citing-cited references of included studies. Two review authors independently screened the studies and extracted the data.ResultsWe identified 13 studies. The one small randomised controlled trial found a non-significant 25% relative increase in antibiotic prescribing in the TH group. The remaining 10 were observational studies but did not control well for confounding, and therefore at high risk of bias. When pooled by specific infections, there was no consistent pattern. The six studies of sinusitis – including one before-after study - showed significantly less prescribing for acute rhinosinusitis in TH consultations, whereas the two studies of acute otitis media showed a significant increase. Pharyngitis, conjunctivitis, and urinary tract infections showed not-significant higher prescribing in the TH group. Bronchitis showed no change.ConclusionsThe impact of telehealth on prescribing appears to vary between conditions with more increases than reductions. However, there is insufficient evidence to draw strong conclusions, and higher quality research is urgently needed.
BackgroundAntibiotics have revolutionised modern medicine; however, since their discovery a century ago, their effectiveness against common infections is waning. Antimicrobial resistance is one of the most important challenges of our time. Reversing the trend of increasing resistance is vital to ensure procedures such as surgery, neonatal care and organ transplants remain safe. Inappropriate use of antibiotics is the most important driver of resistance. As the vast majority of antibiotics are prescribed by general practitioners, primary care has an important part to play in preserving antibiotics for the future.
Background Most antibiotic prescribing for upper respiratory tract infections (URTIs) and acute bronchitis is inappropriate. Substantive and sustained reductions in prescribing are needed to reduce antibiotic resistance. Prescribing habits develop early in clinicians’ careers. Hence, general practice (GP) trainees are an important group to target. Objectives We aimed to establish temporal trends in antibiotic prescribing for URTIs and acute bronchitis/bronchiolitis by Australian GP trainees (registrars). Methods A longitudinal analysis, 2010–2019, of the Registrars Clinical Encounters in Training (ReCEnT) dataset. In ReCEnT, registrars record clinical and educational content of 60 consecutive consultations, on 3 occasions, 6 monthly. Analyses were of new diagnoses of URTI and acute bronchitis/bronchiolitis, with the outcome variable a systemic antibiotic being prescribed. The independent variable of interest was year of prescribing (modelled as a continuous variable). Results 28,372 diagnoses of URTI and 5,289 diagnoses of acute bronchitis/bronchiolitis were recorded by 2,839 registrars. Antibiotic prescribing for URTI decreased from 24% in 2010 to 12% in 2019. Prescribing for acute bronchitis/bronchiolitis decreased from 84% to 72%. “Year” was significantly, negatively associated with antibiotic prescribing for both URTI (odds ratio [OR] 0.90; 95% confidence interval [CI]: 0.88–0.93) and acute bronchitis/bronchiolitis (OR 0.92; 95% CI: 0.88–0.96) on multivariable analysis, with estimates representing the mean annual change. Conclusions GP registrars’ prescribing for URTI and acute bronchitis/bronchiolitis declined over the 10-year period. Prescribing for acute bronchitis/bronchiolitis, however, remains higher than recommended benchmarks. Continued education and programme-level antibiotic stewardship interventions are required to further reduce registrars’ antibiotic prescribing for acute bronchitis/bronchiolitis to appropriate levels.
Background The newest version of the Therapeutic Guidelines’ antibiotic chapter introduced patient- and clinician-facing resources to support decision-making about antibiotic use for self-limiting infections. It is unclear whether general practitioners (GPs) are aware of and use these resources, including the natural history information they contain. We explored GPs’ perceptions of the value and their use of natural history information, and their use of the Therapeutic Guidelines’ resources (summary table, discussion boxes, decision aids) to support antibiotic decision-making. Methods Semi-structured interviews with 21 Australian GPs were conducted. Interviews were recorded, transcribed and thematically analysed by two independent researchers. Results Four themes emerged: (1) GPs perceive natural history information as valuable in consultations for self-limiting conditions and use it for a range of purposes, but desire specific information for infectious and non-infectious conditions; (2) GPs’ reasons for using patient-facing resources were manifold, including managing patients’ expectations for antibiotics, legitimising the decision not to provide antibiotics and as a prescription substitute; (3) the guidelines are a useful and important educational resource, but typically not consulted at the time of deciding whether to prescribe antibiotics; and (4) experience and attitude towards shared decision-making and looking up information during consultations influenced whether GPs involved patients in decision-making and used a decision aid. Conclusions GPs perceived natural history information to be valuable in discussions about antibiotic use for self-limiting conditions. Patient and clinician resources were generally perceived as useful, although reasons for use varied, and a few barriers to use were reported.
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