title: Antibiotic prescribing for sore throat: a cross-sectional analysis of the ReCEnT study exploring the habits of early-career doctors in family practice.
abstract: Acute sore throat is a common condition presenting to family practitioners. It is usually self-limiting, with antibiotic treatment recommended only for high-risk presentations. Overprescribing of antibiotics contributes to individual and community resistance. Learning to prescribe in the context of diagnostic uncertainty and patient pressures is a challenge for early-career doctors. Prescribing habits develop early and tend not to change with time.
  
  
  
  To establish the prevalence and associations of antibiotic prescribing for acute sore throat by Australian vocational trainees in family practice.
  
  
  
  A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study. This ongoing, multicentre prospective cohort study documents the nature of trainees' consultation-based clinical experiences. Univariate and logistic regression analyses were conducted on data recorded in consultations for sore throat in nine collection periods during 2010-14.
  
  
  
  Data from 856 individual trainees (response rate 95.2%) were analysed. Sore throat was managed in 2.3% encounters. Antibiotics were prescribed for 71.5% of sore throat diagnoses. The variables associated with prescribing were inner-regional location and higher socio-economic area. There was no significant association with younger age of patient or greater trainee experience. If an antibiotic was prescribed, the trainee was more likely to seek information from guidelines or a supervisor.
  
  
  
  The high frequency of antibiotic prescribing and the lack of attenuation in prescribing with increased experience suggest current educational interventions and the apprenticeship model of training is not fostering appropriate practice in this important clinical area. Targeted educational interventions, for supervisors as well as trainees, are indicated.
authors.affiliation: Discipline of General Practice, University of Queensland, Brisbane, anthea.dallas@nd.edu.au.
authors.forename: Anthea
authors.initials: A
authors.lastname: Dallas
authors.affiliation: Discipline of General Practice, University of Queensland, Brisbane.
authors.forename: Mieke
authors.initials: M
authors.lastname: van Driel
authors.affiliation: General Practice Training-Valley to Coast, Newcastle.
authors.forename: Simon
authors.initials: S
authors.lastname: Morgan
authors.affiliation: General Practice Training-Valley to Coast, Newcastle.
authors.forename: Amanda
authors.initials: A
authors.lastname: Tapley
authors.affiliation: General Practice Training-Valley to Coast, Newcastle.
authors.forename: Kim
authors.initials: K
authors.lastname: Henderson
authors.affiliation: HMRI/CReDITTS, Newcastle.
authors.forename: Jean
authors.initials: J
authors.lastname: Ball
authors.affiliation: HMRI/CReDITTS, Newcastle.
authors.forename: Chris
authors.initials: C
authors.lastname: Oldmeadow
authors.affiliation: General Practice Training-Valley to Coast, Newcastle.
authors.forename: Andrew
authors.initials: A
authors.lastname: Davey
authors.affiliation: General Practice Training-Valley to Coast, Newcastle.
authors.forename: Kate
authors.initials: K
authors.lastname: Mulquiney
authors.affiliation: Department of Infectious Diseases, John Hunter Hospital, Newcastle, Global and Tropical Health Division, Menzies School of Health Research, Darwin.
authors.forename: Joshua
authors.initials: J
authors.lastname: Davis
authors.affiliation: Victorian Metropolitan Alliance General Practice Training, Melbourne, Department of General Practice, University of Melbourne, Melbourne.
authors.forename: Neil
authors.initials: N
authors.lastname: Spike
authors.affiliation: Adelaide to Outback GP Training Program, Adelaide, Australia and.
authors.forename: Lawrie
authors.initials: L
authors.lastname: McArthur
authors.affiliation: General Practice Training-Valley to Coast, Newcastle, Discipline of General Practice, University of Newcastle, Newcastle, Australia.
authors.forename: Parker
authors.initials: P
authors.lastname: Magin
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001315:Australia; D003430:Cross-Sectional Studies; D024881:Drug Resistance, Bacterial; D005194:Family Practice / Q000193:education*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D010612:Pharyngitis / Q000188:drug therapy*; D010821:Physicians, Family / Q000193:education*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibacterial agents; drug resistance; evidence-based medicine; general practice; graduate medical education; microbial; physician prescribing patterns.