title: Effect of changes in antibiotic prescribing on patient outcomes in a community setting: a natural experiment in Australia.
abstract: This study examined whether a significant change in antibiotic use caused by an Australian government directive targeted at amoxicillin with clavulanic acid (AC) was associated with changes in prescription share, health care costs, and patient outcomes. We used an integrated database of computerized general practice medical records, which included data regarding 34,242 patients and 318,234 recorded patient visits. There were 15,303 antibiotic prescriptions provided to 9921 patients during a 4-year period, with AC prescribed for 1453 (14.6%) of these patients. A total of 5125 patient outcomes were identified. There was a shift away from best-practice antibiotic prescribing, and a significant association was identified between the rate and cost of process-of-care and patient outcomes and the decrease in AC-prescription share. This policy initiative created unintended changes in prescribing behavior, increased costs to the government, and a trend toward poorer patient outcomes. Detailed analyses are required before instigating initiatives aimed at changing clinicians' prescribing behavior.
authors.affiliation: Department of General Practice, University of Adelaide, North Tce, Adelaide, Australia. justin.beilby@adelaide.edu.au
authors.forename: Justin
authors.initials: J
authors.lastname: Beilby
authors.forename: John
authors.initials: J
authors.lastname: Marley
authors.forename: Don
authors.initials: D
authors.lastname: Walker
authors.forename: Nicole
authors.initials: N
authors.lastname: Chamberlain
authors.forename: Michelle
authors.initials: M
authors.lastname: Burke
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001315:Australia; D002648:Child; D002675:Child, Preschool; D003153:Community Health Services / Q000191:economics; D019992:Databases as Topic; D011307:Drug Prescriptions; D004363:Drug Utilization / Q000331:legislation & jurisprudence; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents