Increase in antibiotic prescriptions in Out of Hours primary care while in hours primary care prescriptions decrease: service evaluation in a population of 600,000 patients
Despite the growing importance of antimicrobial guardianship in primary care, there have been no published evaluations of antibiotic prescribing practices in Out-of-Hours services in the UK. Concerns exist that governmental drives to decrease antimicrobial prescribing in in-hours primary care may displace antibiotic prescribing to the OOH service but there is, as yet, little evidence to substantiate these fears.
In this retrospective service evaluation we established a database of 496942 patient contacts to Oxfordshire OOH primary care between May 2010 and August 2014, including details of patient demographics and antibiotic prescriptions. Comparison of time trends in antibiotic prescriptions from OOH primary care and in-hours primary care for the same population was made using multiple linear regression models fitted to the monthly data for out of hours prescriptions, out of hours contacts and in hours prescriptions between September 2010 and August 2014.
Compared to the overall population contacting the OOH service, younger age, female sex, and lower deprivation score were all independently correlated with an increased chance of a contact resulting in prescription of antibiotics. The majority of antibiotics were prescribed to patients who received only 1 antibiotic from the OOH service in 4 years and to patients contacting the service at weekends. The most commonly prescribed antibiotics were penicillins; amoxicillin accounted for 28.2% of all prescriptions issued. Despite a reduction in patient contacts with the OOH service (an estimated decrease of 486.5 monthly contacts each year (CI: −676.3 to −296.8)), antibiotic prescriptions from this service rose during the study period (increase of 37.1 monthly prescriptions each year (CI: 10.6 to 63.7)). A matching increase was not seen for in-hours antibiotic prescriptions, and the difference between the year trend for out of hours and in hours prescriptions was significant (Z test, p = 0.002**). The trend in out of hours prescription proportion (antibiotic prescriptions per contact) was suggestive of an impact of the introduction of the ‘111’ telephone triage service.
We have demonstrated trends in prescribing which could represent a partial displacement of antibiotic prescribing from in hours to OOH primary care. There would be merit in examining this more closely across a range of OOH service providers to see if the trends we describe are evident nationally.