Association of GP Burnout with increased Prescribing of Strong Opioids and Antibiotics

Problem

The rise in prescriptions of strong opioids in the UK and globally has led to concerns of an epidemic crisis, and a recent review by Public Health England indicated that at least 20% of antibiotics prescribed in primary care in England were inappropriate.

There is increasing evidence internationally that the wellbeing of physicians including GPs is associated with poor quality of care outcomes including medication and prescription errors. A key marker of health care staff well-being is ‘burnout’ and the closely related characteristics that associate with burnout include depersonalisation, turnover intention, career regret and job dissatisfaction.

Due to lack of awareness regarding the impacts GP burnout and wellbeing might have on the individual healthcare system, in this study we aim to assess which characteristics of general practices are associated with markers of suboptimal patient care focusing on the volume/potentially hazardous prescribing of strong opioids and antibiotics using data from the RCGP Research and Surveillance Centre (RSC).

Approach

A retrospective cohort study linking patient prescribing data from the RCGP RSC with GP responses from December 2020 to April 2021. All patients aged 18 years and over with any indication of chronic pain whilst being prescribed strong opioids and patients with any acute lower respiratory tract infection being prescribed antibiotics. Burnout was measured using the Maslach Burnout Inventory. Logistic regressions assessed the relationship between high-level GP burnout with individual prescribing and patient-level factors.

Findings

In 40,227 patients (13,483 users of strong opioids and 26,744 users of antibiotics) from the RCGP RSC linked to 57 practices and 620 GPs; logistic regressions for opioid prescribing, showed that GPs with a high level of burnout were significantly associated with greater prescribing (OR=1.82, 95%CI 1.32 to 2.52) in patients aged 40 or below compared with middle aged patients between 40 to 60 (OR=0.63, 95%CI 0.49 to 0.81), in male patients compared to female patients (OR=0.45, 95%CI 0.14 to 0.86), more deprived patients (OR=0.43, 95%CI 0.24 to 0.57) and practices based in the north-west region of England (OR=2.17, 95%CI 1.46 to 3.42). For antibiotic use, there was a greater association of high GP burnout with greater prescribing (OR=1.58, 95%CI 1.13 to 2.22) in patients aged below 40 compared with middle aged patients (OR=0.51, 95%CI 0.39 to 0.68), and in practices based in the north-east and Yorkshire region of England (OR=1.42, 95%CI 1.19 to 1.83).

Consequences

Greater prescribing of strong opioids and antibiotics was associated with high burnout amongst GPs in practices in England. This association for opioids was strongest in younger deprived male patients living the North-West region of England, and for antibiotics it was strongest in patients below the age of 40 and living in the North-East and Yorkshire region of England. Similar efforts, but directly linking GP responses with patient care, would help to better understand which individual GP factors are most associated with strong opioid and antibiotic prescribing in the UK.