Financial incentives could help reduce unnecessary antibiotic prescribing

nocebo pills

A study by researchers at Imperial College London and Public Health England has shown the number of patients prescribed antibiotics by their GP for a common respiratory infection decreased significantly following the introduction of a national incentive scheme for the NHS. This is the first study to assess the impact of such a scheme and shows that financial rewards helped to reduce antibiotic prescriptions for common respiratory tract infections by 3 percent, particularly among children. The study team says the approach could help to tackle the excessive use of antibiotics in the community. The use of antibiotics in cases where they may offer only limited clinical benefit is a key driver in the rise of drug-resistant bacteria.

In England, respiratory tract infections (RTIs), which include coughs and sore throats, are one of the most common reasons for a visit to the GP, and GP clinics the most common setting where doctors prescribe antibiotics. However, many mild RTIs may clear up without treatment, and the majority are caused by viruses, in which case antibiotics are ineffective as they only work against bacteria.

GPs are currently unable to identify whether an infection is caused by a bacteria or virus, explained Sabine Bou-Antoun, an epidemiologist and research postgraduate at the School of Public Health at Imperial and first author of the study: “In clinic, GPs have a short amount of time in which to see a patient, make a diagnosis and recommend a treatment where required. For respiratory infections, this is complicated further by unspecific symptoms and lack of a ‘point-of-care’ diagnostic tool to distinguish between a bacterial and viral respiratory infection. This clinical uncertainty, along with patient anxiety regarding their infection, or their child’s, may influence the decision to prescribe antibiotics. We do however know that respiratory tract infections are commonly viral and that they are likely to resolve without antibiotic treatment and, so antibiotics are likely to offer little benefit to these patients.”

As part of a wider approach to reducing the growth of antimicrobial resistance (where overuse of antibiotics is driving drug-resistant infections, making antibiotics less effective), the NHS is trying to reduce antibiotic prescriptions in the community with schemes which include financial incentives for commissioners. In this study, the team reviewed data from general practices across England, focusing on prescribing of antibiotics for uncomplicated RTIs from 2011 to 2017.

Their analysis revealed that aside from the expected seasonal peaks and troughs associated with winter and summer periods, prescribing rates fell by 3 percent, or 14.65 prescriptions per 1000 RTIs, in April 2015 – coinciding with the introduction of the incentive scheme around antibiotic prescribing. Their analysis also showed a reduction in the rate of prescriptions for broad-spectrum antibiotics for RTIs. According to the group further research is currently being undertaken to follow up on the findings to establish whether reductions in antibiotic prescribing in primary care is associated with any negative impacts, including increased illness.

This research was funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London in partnership with PHE, and the NIHR Imperial BRC.

You can read the full story by Ryan O’Hare here.