Changes in early-career family physicians' antibiotic prescribing for upper respiratory tract infection and acute bronchitis: a multicentre longitudinal study.
Inappropriate antibiotic prescription and subsequent antibacterial resistance are major threats to health worldwide.



We aimed to establish whether early-career 'apprenticeship-model' experience in family practice influences antibiotic prescribing for respiratory tract infections and to also establish other associations of antibiotic prescribing changes during this early-career experience.



A longitudinal analysis (2010-2014) of a cohort study of Australian GP registrars' (vocational trainees') consultations. Registrars from five regional training programs recorded data from 60 consecutive consultations, once each 6-month training Term, including the diagnoses managed and medications prescribed. The outcomes were whether an antibiotic was prescribed for the diagnoses 'upper respiratory tract infection (URTI)' and 'acute bronchitis/bronchiolitis'. Generalized linear mixed modelling was used to account for repeated measures on registrars and to include the time component: 'Term'.



A total of 856 registrars recorded 108759 consultations, including 8715 'URTI' diagnoses (5.15% of diagnoses) and 2110 'acute bronchitis/bronchiolitis' diagnoses (1.25%). Antibiotics were prescribed in 16.3% [95% confidence interval (CI) 14.9-17.8] of URTI and 72.2% (95% CI 69.6-74.6) of acute bronchitis/bronchiolitis diagnoses. Moving from an earlier to later term did not significantly influence registrars' antibiotic prescribing for URTI [adjusted odds ratio (OR) 0.95; 95% CI 0.87, 1.04, P = 0.27] or acute bronchitis/bronchiolitis [OR 1.01 (95% CI 0.90-1.14), P = 0.86]. Significant associations of antibiotic prescribing for URTIs were the registrar being non-Australian educated, greater patient age, practices not privately billing patients, pathology being ordered, longer consultation duration and the registrar seeking in-consultation information or advice (including from their supervisor).



Early-career experience/training failed to produce rational antibiotic prescribing for URTI and acute bronchitis/bronchiolitis. Our findings suggest that prescribing interventions could target the registrar-supervisor dyad.
School of Medicine and Public Health, University of Newcastle, Callaghan, NSW General Practice Training-Valley to Coast, Mayfield, NSW parker.magin@newcastle.edu.au.
Parker J
PJ
Magin
General Practice Training-Valley to Coast, Mayfield, NSW.
Simon
S
Morgan
General Practice Training-Valley to Coast, Mayfield, NSW.
Amanda
A
Tapley
General Practice Training-Valley to Coast, Mayfield, NSW.
Kim M
KM
Henderson
Hunter Medical Research Institute, CReDITTS, New Lambton Heights, NSW.
Elizabeth G
EG
Holliday
Hunter Medical Research Institute, CReDITTS, New Lambton Heights, NSW.
Jean
J
Ball
School of Medicine and Public Health, University of Newcastle, Callaghan, NSW Menzies School of Health Research, Royal Darwin Hospital Campus, Casuarina, NT John Hunter Hospital, New Lambton Heights, NSW.
Joshua S
JS
Davis
Discipline of General Practice, University of Queensland, Brisbane, QLD.
Anthea
A
Dallas
School of Medicine and Public Health, University of Newcastle, Callaghan, NSW.
Andrew R
AR
Davey
Victorian Metropolitan Alliance General Practice Training, Hawthorn, VIC Department of General Practice, University of Melbourne, Carlton, VIC.
Neil A
NA
Spike
Adelaide to Outback GP Training Program, North Adelaide, SA and.
Lawrie
L
McArthur
Tropical Medical Training, Townsville, QLD Australia.
Rebecca
R
Stewart
General Practice Training-Valley to Coast, Mayfield, NSW.
Katie J
KJ
Mulquiney
Discipline of General Practice, University of Queensland, Brisbane, QLD.
Mieke L
ML
van Driel
D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001315:Australia; D001991:Bronchitis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010821:Physicians, Family / Q000193:education; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D012017:Referral and Consultation / Q000706:statistics & numerical data
D000900:Anti-Bacterial Agents
Antibacterial agents; family practice; general practice; inappropriate prescribing; physician practice patterns; respiratory tract infections.