Changes in early-career family physicians' antibiotic prescribing for upper respiratory tract infection and acute bronchitis: A multicentre longitudinal study

Magin, Parker J., Morgan, Simon, Tapley, Amanda, Henderson, Kim M., Holliday, Elizabeth G., Ball, Jean, Davis, Joshua S., Dallas, Anthea, Davey, Andrew R., Spike, Neil A., McArthur, Lawrie, Stewart, Rebecca, Mulquiney, Katie J., and Van Driel, Mieke L. (2016) Changes in early-career family physicians' antibiotic prescribing for upper respiratory tract infection and acute bronchitis: A multicentre longitudinal study. Family Practice, 33 (4). pp. 360-367.

[img] PDF (Published Version) - Published Version
Restricted to Repository staff only

View at Publisher Website:


Background. Inappropriate antibiotic prescription and subsequent antibacterial resistance are major threats to health worldwide. Objectives. 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.

Methods. 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'.

Results. 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).

Conclusions. 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.

Item ID: 75252
Item Type: Article (Research - C1)
ISSN: 1460-2229
Keywords: Antibacterial agents, Family practice, General practice, Inappropriate prescribing, Physician practice patterns, Respiratory tract infections
Copyright Information: © The Author 2016. Published by Oxford University Press. All rights reserved.
Date Deposited: 18 Aug 2022 02:09
FoR Codes: 42 HEALTH SCIENCES > 4203 Health services and systems > 420304 General practice @ 80%
39 EDUCATION > 3901 Curriculum and pedagogy > 390110 Medicine, nursing and health curriculum and pedagogy @ 20%
More Statistics

Actions (Repository Staff Only)

Item Control Page Item Control Page