Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
Nuffield Department of Primary Care Sciences, University of Oxford, Oxford, UK.
BMJ Open. 2019 Sep 3;9(8):e030093. doi: 10.1136/bmjopen-2019-030093.
The persistent development and spread of resistance to antibiotics remain an important public health concern in the UK and globally. About 74% of antibiotics prescribed in England in 2016 was in primary care. The Quality Premium (QP) initiative that rewards Clinical Commissioning Groups (CCGs) financially based on the quality of specific health services commissioned is one of the National Health Service (NHS) England interventions to reduce antimicrobial resistance through reduced prescribing. Emerging evidence suggests a reduction in antibiotic prescribing in primary care practices in the UK following QP initiative. This study aims to investigate the mechanism of impact of this high-cost health-system level intervention on antibiotic prescribing in primary care practices in England.
The study will constitute secondary analyses of antibiotic prescribing data for almost all primary care practices in England from the NHS England Antibiotic Quality Premium Monitoring Dashboard and OpenPrescribing covering the period 2013 to 2018. The primary outcome is the number of antibiotic items per Specific Therapeutic group Age-sex Related Prescribing Unit (STAR-PU) prescribed monthly in each practice or CCG. We will first conduct an interrupted time series using ordinary least square regression method to examine whether antibiotic prescribing rate in England has changed over time, and how such changes, if any, are associated with QP implementation. Single and sequential multiple-mediator models using a unified approach for the natural direct and indirect effects will be conducted to investigate the relationship between QP initiative, the potential mediators and antibiotic prescribing rate with adjustment for practice and CCG characteristics.
This study will use secondary data that are anonymised and obtained from studies that have either undergone ethical review or generated data from routine collection systems. Multiple channels will be used in disseminating the findings from this study to academic and non-academic audiences.
抗生素耐药性的持续发展和传播仍然是英国和全球公共卫生的一个重要关注点。2016 年，在英格兰开处的抗生素中，约有 74%是在初级保健中开的。质量溢价（QP）计划根据委托特定卫生服务的质量对临床委托组（CCG）进行经济奖励，是英国国民保健制度（NHS）减少抗生素耐药性的干预措施之一，该计划通过减少处方来实现。有新的证据表明，在 QP 计划实施后，英国初级保健实践中的抗生素处方有所减少。本研究旨在调查这一高成本卫生系统层面干预措施对英格兰初级保健实践中抗生素处方的影响机制。
本研究将对英国国民保健制度抗生素质量溢价监测仪表板和 OpenPrescribing 中几乎所有英格兰初级保健实践的抗生素处方数据进行二次分析，涵盖 2013 年至 2018 年期间的数据。主要结果是每个实践或 CCG 每月按特定治疗组年龄性别相关处方单位（STAR-PU）开出的抗生素数量。我们将首先使用普通最小二乘法回归方法进行中断时间序列分析，以检验英格兰的抗生素处方率是否随时间发生变化，以及如果有任何变化，这些变化与 QP 实施有何关联。使用统一方法进行单一和顺序多重中介模型分析，以调查 QP 计划、潜在中介因素与抗生素处方率之间的关系，同时调整实践和 CCG 特征。
本研究将使用二级数据，这些数据是匿名的，并且是从已经经过伦理审查的研究中获得的，或者是从常规收集系统中生成的数据。将使用多种渠道向学术和非学术受众传播本研究的发现。
