Antibiotic prescribing and patient satisfaction in primary care: a cross-sectional analysis of national patient survey data and prescribing data in England

The problem

Given the growing dangers from antibiotic resistant bacteria there have been many attempts to limit antibiotic prescribing in general practice. In spite of this, antibiotic prescribing by GPs increased by 4% from 2010 to 2013. There appears to be scope for further antibiotic reduction as suggested by recent evidence that many upper respiratory infections, mainly of viral origin, continue to be treated with antibiotics. Concerns about the effect on patient satisfaction may be an important obstacle to attempts to curtail antibiotic prescribing. We therefore aimed to determine the relationship between antibiotic prescribing in general practice and reported patient satisfaction.

The approach

We obtained data from the General Practice Patient Survey (GPPS) in 2012 (2.7 million questionnaires in England; 982,999 responses; response rate 36%); the national Quality and Outcomes Framework (QOF) dataset for England, 2011/12 (8164 general practices); general practice and demographic characteristics. Standardised measures of antibiotic prescribing volume in each general practice were obtained, together with 12 other nationally available prescribing variables (including overall prescribing cost and measures of other drug categories). We constructed regression models to identify the role of antibiotic prescribing volume as a determinant of GPPS scores, adjusted for demographic and practice factors. We only included GPPS scores for variables which might have been influenced by the GP decision to prescribe antibiotics; thus we included the responses to all 'doctor satisfaction' (n = 6) and 'overall satisfaction' (n = 2) questions; other GPPS variables were excluded.

Findings

Our final dataset consisted of 7800 (95.5%) practices. A total of 33.7 million antibiotic prescriptions were issued to a registered population of 53.8 million patients. Antibiotic prescribing volume (standardised) was a significant predictor of all ‘doctor satisfaction' and ‘practice satisfaction' scores in the GPPS, and was the strongest predictor of overall satisfaction out of the 13 prescribing variables. The eight regression models had a relatively high predictive power ranging from an r2 value of 20.0% to 30.1%; the adjusted regression coefficient, B, ranged from 1.98 to 4.07. The B value allowed direct estimation of the degree to which patient satisfaction varied according to the volume of antibiotic prescribing: a theoretical 50% reduction in antibiotic prescribing volume would be associated with 1.0% to 2.0% lower patient satisfaction scores.

Consequences

Our findings suggest that frugal antibiotic prescribing is associated with modest reductions in patient satisfaction. Although observational studies cannot prove a causal relationship, our findings are consistent with other studies based on patient-level data.A cautious approach to antibiotic prescribing may require a trade-off in terms of patient satisfaction. GP's who wish to play their part in addressing issues of antibiotic resistance will be supported by a better understanding of alternatives to an antibiotic prescription which also enhance patient satisfaction

Credits

• Mark Ashworth
• Patrick White
• Hannah Jongsma
• David Armstrong
• Peter Schofield