Turner Alexandria, van Driel Mieke L, Mitchell Ben, Holliday Elizabeth, Davis Josh, Tapley Amanda, Davey Andrew, Ralston Anna, Dizon Jason, Baillie Emma, Fielding Alison, Mulquiney Katie, Clarke Lisa, Spike Neil, Magin Parker
General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
GP Training Research, Royal Australian College of General Practitioners, Mayfield West, New South Wales, Australia.
BMJ Open. 2025 Aug 3;15(8):e094811. doi: 10.1136/bmjopen-2024-094811.
OBJECTIVES: Frequency of general practitioners' (GPs') antibiotic prescribing for acute, self-limiting respiratory tract infections (aRTIs) is high. The practice environment and culture influence the clinical behaviour, including prescribing behaviour, of GP specialist vocational trainees (registrars). We aimed to assess inter-practice variability in registrars' antibiotic prescribing. DESIGN: This was a cross-sectional analysis from the Registrar Clinical Encounters in Training (ReCEnT) cohort study, from 2010 to 2020. SETTING: ReCEnT documents registrars' clinical experiences and behaviours. Before 2016, 5 of 17 Australian training regions participated in ReCEnT. From 2016, three of nine regions (~40% of Australian registrars) participated. PARTICIPANTS: 3210 registrars (response rate 91.8%) from 1286 training practices contributed to the analysis. OUTCOME MEASURES: The outcomes were prescription of an antibiotic for new diagnoses of (1) all aRTIs and (2) acute bronchitis diagnoses specifically. Prescribing percentages were calculated at the training practice level. Intraclass correlation coefficients (ICCs) were used to measure the ratio of interpractice variation to total variance. Median ORs (MORs) were also estimated to quantify interpractice variability. RESULTS: Practice-level antibiotic prescribing percentages ranged from 0% to 100% for both aRTIs and acute bronchitis diagnoses in the primary analysis. ICCs for aRTI prescribing were 0.08 (unadjusted) and 0.02 (adjusted). For acute bronchitis, ICCs were 0.10 (unadjusted) and 0.05 (adjusted). MORs were 1.66 (unadjusted) and 1.32 (adjusted) for aRTIs. MORs for acute bronchitis were 1.80 (unadjusted) and 1.53 (adjusted). This indicates a marked variation in the odds of a patient receiving antibiotics for an aRTI if randomly attending different practices. CONCLUSIONS: There was considerable interpractice variation in registrars' antibiotic prescribing frequencies. Further research is required to examine the factors accounting for this variation and to develop practice-level interventions to reduce antibiotic prescribing in high-prescribing practices.
目的：全科医生（GP）针对急性自限性呼吸道感染（aRTI）开具抗生素的频率很高。执业环境和文化会影响GP专科职业培训学员（注册医生）的临床行为，包括处方行为。我们旨在评估注册医生抗生素处方的诊所间差异。 设计：这是一项对2010年至2020年注册医生临床培训 encounters（ReCEnT）队列研究的横断面分析。 设置：ReCEnT记录了注册医生的临床经验和行为。2016年前，澳大利亚17个培训地区中的5个参与了ReCEnT。从2016年起，9个地区中的3个（约占澳大利亚注册医生的40%）参与其中。 参与者：来自1286个培训诊所的3210名注册医生（回复率91.8%）参与了分析。 结果指标：结果是针对（1）所有aRTI新诊断病例和（2）急性支气管炎诊断病例开具抗生素的情况。在培训诊所层面计算处方百分比。组内相关系数（ICC）用于衡量诊所间差异与总方差的比率。还估计了中位数比值比（MOR）以量化诊所间差异。 结果：在初步分析中，aRTI和急性支气管炎诊断的诊所层面抗生素处方百分比范围为0%至100%。aRTI处方的ICC未调整时为0.08，调整后为0.02。对于急性支气管炎，ICC未调整时为0.10，调整后为0.05。aRTI的MOR未调整时为1.66，调整后为1.32。急性支气管炎的MOR未调整时为1.80，调整后为1.53。这表明如果患者随机就诊于不同诊所，其因aRTI接受抗生素治疗的几率存在显著差异。 结论：注册医生的抗生素处方频率在诊所间存在相当大的差异。需要进一步研究以检查造成这种差异的因素，并制定诊所层面的干预措施以减少高处方诊所的抗生素处方。
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