Variations in antibiotic prescribing and consultation rates for acute respiratory infection in UK general practices 1995-2000

Abstract

Background: Antibiotic prescribing by GPs in the UK has declined since 1995.

Aim: We investigated whether general practices that issue fewer antibiotic prescriptions to patients presenting with acute respiratory infections had lower consultation rates for these conditions.

Design of study: Retrospective data analysis.

Setting: UK general practice.

Method: We analysed data from the General Practice Research Database, including all registered patients from 108 practices between 1995 and 2000. For each practice, numbers of consultations for acute respiratory tract infections and the proportion of consultations resulting in an antibiotic prescription were obtained. An age- and sex-standardised consultation ratio (SCR) and standardised prescription ratio (SPR) were calculated for each practice. We evaluated whether SPR and SCR values were associated.

Results: For the mid-year data (1997), the crude consultation rate for all acute respiratory infections ranged from 125-1,110 per 1,000 registered patients at different practices; the proportion of consultations with antibiotics prescribed ranged from 45-98%. After standardising for varying age and sex structure of practice populations, practices with lower SPR values had lower SCR values (r = 0.41; P<0.001). This association was observed in each study year. Moreover, practices that demonstrated reductions in SPR between 1995 and 2000 also showed reductions in SCR (r = 0.27; P = 0.005).

Conclusion: Practices that prescribe antibiotics to a smaller proportion of patients presenting with acute respiratory infections have lower consultation rates for these conditions. Practices that succeed, over time, in reducing antibiotic prescribing also experience reductions in consultation rates for these conditions. Although our methodology cannot prove that these two findings are causally related, they imply that patients alter their illness behaviour and that this may be a response to previous consultation experience. In consequence, respiratory illness in the community may be undergoing a process of de-medicalisation.