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Does practice characteristics explain the impact of a financial incentive on antibiotic prescribing?

Anyanwu, P. and Costelloe, C. 2019. Does practice characteristics explain the impact of a financial incentive on antibiotic prescribing? Presented at: European Public Health Conference 2019, Marseille, France, 20-23 November 2019. European Journal of Public Health. , vol.29 (Supple) Oxford University Press, ckz185.287. 10.1093/eurpub/ckz185.287

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Abstract

Background About 80% of the antibiotics prescribed in England are from primary care practices. The Quality Premium (QP) initiative that offers financial rewards on the quality of specific health services commissioned is one of the NHS England interventions to reduce antimicrobial resistance through reduced prescribing. Evaluations of the initiative suggest a reduction in antibiotic prescribing in primary care. We investigated whether the effect of this financial incentive on antibiotic prescribing is explained by variations in practice characteristics that can contribute to differences in antibiotic prescribing. Methods We used monthly prescribing data for 6,600 practices in England from NHS Digital for the year from April 2015 when antibiotic improvement was included as a QP priority and the preceding year. We fitted an initial linear generalised estimating equations model examining the effect of the incentive on antibiotic items/STAR-PU prescribed, adjusting for seasonality and number of months since implementation. We examined the consistency of the effect after the initial model was adjusted for variations in workforce, prevalence of co-morbidities (asthma, COPD, cancer, chronic kidney disease, diabetes), and deprivation index. Results Antibiotics prescribed in primary care practices in England reduced by 0.20 items/STAR-PU (95% CI:0.19-0.21) after the implementation of the initiative. This reduction flattened off in the following months with a month-on-month increase of 0.013 items (95% CI:0.012-0.013). After adjusting for practice characteristics, the immediate and month-on-month impacts remained consistent with slight attenuation of the immediate impact (0.18, 95% CI:0.17-0.18). Subgroup analyses showed the effect of the initiative was significantly more among 20% top prescribers. Conclusions Variations in practice characteristics are not a major explanation for the impact of the quality premium initiative on antibiotic prescribing in primary care practices in England. Key messages Our findings on the targeted impact of a financial incentive scheme to improve antibiotics prescribing on high prescribers are important to policymakers and antibiotic stewardship programs. Variations in practice characteristics are not a major explanation for the impact of a financial incentive scheme on antibiotics prescribing in primary care practices in England.

Item Type: Conference or Workshop Item (Paper)
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: Oxford University Press
ISSN: 1101-1262
Last Modified: 05 Jan 2024 05:35
URI: https://orca.cardiff.ac.uk/id/eprint/134839

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