Influenza-like illness and antimicrobial prescribing in Australian general practice from 2015 to 2017: a national longitudinal study using the MedicineInsight dataset

ObjectivesTo investigate the epidemiology of influenza-like illness (ILI) by general practice and patient characteristics, and explore whether sociodemographic variables or comorbidities affect antiviral or antibiotic prescribing.DesignOpen cohort study.SettingA representative sample of 550 Australi...

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Published in:BMJ open 2019-05, Vol.9 (4), p.e026396-e026396
Main Authors: Bernardo, Carla De Oliveira, Gonzalez-Chica, David, Stocks, Nigel
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Ambulatory care
Anti-Bacterial Agents - pharmacology
Antibiotics
Antiviral drugs
Australia - epidemiology
Child
Child, Preschool
Comorbidity
Databases, Factual
Drug Prescriptions - statistics & numerical data
Ethnicity
Female
General Practice - statistics & numerical data
General practice / Family practice
Humans
Illnesses
Incidence
Infections
Influenza
Influenza, Human - drug therapy
Influenza, Human - epidemiology
Longitudinal studies
Male
Medical records
Middle Aged
Patients
Pediatrics
Practice Patterns, Physicians
Primary care
Retrospective Studies
Sociodemographics
Young Adult
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Gonzalez-Chica, David
Stocks, Nigel
description ObjectivesTo investigate the epidemiology of influenza-like illness (ILI) by general practice and patient characteristics, and explore whether sociodemographic variables or comorbidities affect antiviral or antibiotic prescribing.DesignOpen cohort study.SettingA representative sample of 550 Australian general practices contributing data to the MedicineInsight programme.Participants4 228 149 patients of all age groups who had at least one consultation between 2015 and 2017. Median age was 37 years (Interquartile range: 21–57), 54.4% women, 16.4% aged ≥65 years, 2.2% Aboriginal or Torres Strait Islander, 17.6% had a chronic disease and 18.1% a mental health condition.Primary and secondary outcome measuresILI consultation rates (per 1000 consultations) were calculated using all ILI diagnoses for all clinical encounters with a general practitioner between 2015 and 2017. Antiviral and antibiotic prescribing for ILI cases were investigated and logistic regression models adjusted for practice and patient characteristics used to analyse associations.ResultsILI consultation rates in 2017 were higher than in previous years. Antiviral prescribing increased from 20.6% in 2015, to 23.7 in 2016 and 29.7% in 2017, while antibiotic prescribing decreased from 30.3% to 28.0% and 26.7%, respectively (p
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Median age was 37 years (Interquartile range: 21–57), 54.4% women, 16.4% aged ≥65 years, 2.2% Aboriginal or Torres Strait Islander, 17.6% had a chronic disease and 18.1% a mental health condition.Primary and secondary outcome measuresILI consultation rates (per 1000 consultations) were calculated using all ILI diagnoses for all clinical encounters with a general practitioner between 2015 and 2017. Antiviral and antibiotic prescribing for ILI cases were investigated and logistic regression models adjusted for practice and patient characteristics used to analyse associations.ResultsILI consultation rates in 2017 were higher than in previous years. Antiviral prescribing increased from 20.6% in 2015, to 23.7 in 2016 and 29.7% in 2017, while antibiotic prescribing decreased from 30.3% to 28.0% and 26.7%, respectively (p&lt;0.05 in both cases). Practices located in high socioeconomic areas had higher ILI consultation rates (4.3 vs 2.5 per 1000 consultations, p&lt;0.05), antibiotic (30.7% vs 23.4%, p&lt;0.05) and antiviral (34.2% vs 13.5%, p&lt;0.05) prescribing than those in lower socioeconomic areas. The coexistence of chronic or mental health conditions was associated with lower ILI consultation rates, higher antibiotic use, but not with antiviral prescribing. However, those with chronic respiratory conditions had a higher frequency of antibiotic and antiviral prescribing in 2017 than individuals with other comorbidities.ConclusionsAlthough the apparent decline in antibiotic prescribing for ILI is welcome, the increase in antiviral use may not be targeting those at high risk of complications from infection.</description><identifier>ISSN: 2044-6055</identifier><identifier>EISSN: 2044-6055</identifier><identifier>DOI: 10.1136/bmjopen-2018-026396</identifier><identifier>PMID: 31048440</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Adolescent ; Adult ; Aged ; Ambulatory care ; Anti-Bacterial Agents - pharmacology ; Antibiotics ; Antiviral drugs ; Australia - epidemiology ; Child ; Child, Preschool ; Comorbidity ; Databases, Factual ; Drug Prescriptions - statistics &amp; numerical data ; Ethnicity ; Female ; General Practice - statistics &amp; numerical data ; General practice / Family practice ; Humans ; Illnesses ; Incidence ; Infections ; Influenza ; Influenza, Human - drug therapy ; Influenza, Human - epidemiology ; Longitudinal studies ; Male ; Medical records ; Middle Aged ; Patients ; Pediatrics ; Practice Patterns, Physicians ; Primary care ; Retrospective Studies ; Sociodemographics ; Young Adult</subject><ispartof>BMJ open, 2019-05, Vol.9 (4), p.e026396-e026396</ispartof><rights>Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2019 Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b501t-73d0dadd63689f51e3cfd2860f6e63fb9447aac8d005905b043c1887cb872b8e3</citedby><cites>FETCH-LOGICAL-b501t-73d0dadd63689f51e3cfd2860f6e63fb9447aac8d005905b043c1887cb872b8e3</cites><orcidid>0000-0002-9018-0361 ; 0000-0001-6998-6419 ; 0000-0002-7153-2878</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2220598309/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2220598309?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>112,113,230,314,727,780,784,885,3193,25752,27548,27549,27923,27924,37011,37012,44589,53790,53792,74997,77465,77466,77472,77503</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31048440$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bernardo, Carla De Oliveira</creatorcontrib><creatorcontrib>Gonzalez-Chica, David</creatorcontrib><creatorcontrib>Stocks, Nigel</creatorcontrib><title>Influenza-like illness and antimicrobial prescribing in Australian general practice from 2015 to 2017: a national longitudinal study using the MedicineInsight dataset</title><title>BMJ open</title><addtitle>BMJ Open</addtitle><description>ObjectivesTo investigate the epidemiology of influenza-like illness (ILI) by general practice and patient characteristics, and explore whether sociodemographic variables or comorbidities affect antiviral or antibiotic prescribing.DesignOpen cohort study.SettingA representative sample of 550 Australian general practices contributing data to the MedicineInsight programme.Participants4 228 149 patients of all age groups who had at least one consultation between 2015 and 2017. Median age was 37 years (Interquartile range: 21–57), 54.4% women, 16.4% aged ≥65 years, 2.2% Aboriginal or Torres Strait Islander, 17.6% had a chronic disease and 18.1% a mental health condition.Primary and secondary outcome measuresILI consultation rates (per 1000 consultations) were calculated using all ILI diagnoses for all clinical encounters with a general practitioner between 2015 and 2017. Antiviral and antibiotic prescribing for ILI cases were investigated and logistic regression models adjusted for practice and patient characteristics used to analyse associations.ResultsILI consultation rates in 2017 were higher than in previous years. Antiviral prescribing increased from 20.6% in 2015, to 23.7 in 2016 and 29.7% in 2017, while antibiotic prescribing decreased from 30.3% to 28.0% and 26.7%, respectively (p&lt;0.05 in both cases). Practices located in high socioeconomic areas had higher ILI consultation rates (4.3 vs 2.5 per 1000 consultations, p&lt;0.05), antibiotic (30.7% vs 23.4%, p&lt;0.05) and antiviral (34.2% vs 13.5%, p&lt;0.05) prescribing than those in lower socioeconomic areas. The coexistence of chronic or mental health conditions was associated with lower ILI consultation rates, higher antibiotic use, but not with antiviral prescribing. 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Gonzalez-Chica, David ; Stocks, Nigel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b501t-73d0dadd63689f51e3cfd2860f6e63fb9447aac8d005905b043c1887cb872b8e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Ambulatory care</topic><topic>Anti-Bacterial Agents - pharmacology</topic><topic>Antibiotics</topic><topic>Antiviral drugs</topic><topic>Australia - epidemiology</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Comorbidity</topic><topic>Databases, Factual</topic><topic>Drug Prescriptions - statistics &amp; numerical data</topic><topic>Ethnicity</topic><topic>Female</topic><topic>General Practice - statistics &amp; numerical data</topic><topic>General practice / Family practice</topic><topic>Humans</topic><topic>Illnesses</topic><topic>Incidence</topic><topic>Infections</topic><topic>Influenza</topic><topic>Influenza, Human - drug therapy</topic><topic>Influenza, Human - epidemiology</topic><topic>Longitudinal studies</topic><topic>Male</topic><topic>Medical records</topic><topic>Middle Aged</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Practice Patterns, Physicians</topic><topic>Primary care</topic><topic>Retrospective Studies</topic><topic>Sociodemographics</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bernardo, Carla De Oliveira</creatorcontrib><creatorcontrib>Gonzalez-Chica, David</creatorcontrib><creatorcontrib>Stocks, Nigel</creatorcontrib><collection>BMJ Journals (Open Access)</collection><collection>BMJ Journals:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing and Allied Health Journals</collection><collection>Health &amp; 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Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Psychology Database</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>Publicly Available Content (ProQuest)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bernardo, Carla De Oliveira</au><au>Gonzalez-Chica, David</au><au>Stocks, Nigel</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Influenza-like illness and antimicrobial prescribing in Australian general practice from 2015 to 2017: a national longitudinal study using the MedicineInsight dataset</atitle><jtitle>BMJ open</jtitle><addtitle>BMJ Open</addtitle><date>2019-05-01</date><risdate>2019</risdate><volume>9</volume><issue>4</issue><spage>e026396</spage><epage>e026396</epage><pages>e026396-e026396</pages><issn>2044-6055</issn><eissn>2044-6055</eissn><abstract>ObjectivesTo investigate the epidemiology of influenza-like illness (ILI) by general practice and patient characteristics, and explore whether sociodemographic variables or comorbidities affect antiviral or antibiotic prescribing.DesignOpen cohort study.SettingA representative sample of 550 Australian general practices contributing data to the MedicineInsight programme.Participants4 228 149 patients of all age groups who had at least one consultation between 2015 and 2017. Median age was 37 years (Interquartile range: 21–57), 54.4% women, 16.4% aged ≥65 years, 2.2% Aboriginal or Torres Strait Islander, 17.6% had a chronic disease and 18.1% a mental health condition.Primary and secondary outcome measuresILI consultation rates (per 1000 consultations) were calculated using all ILI diagnoses for all clinical encounters with a general practitioner between 2015 and 2017. Antiviral and antibiotic prescribing for ILI cases were investigated and logistic regression models adjusted for practice and patient characteristics used to analyse associations.ResultsILI consultation rates in 2017 were higher than in previous years. Antiviral prescribing increased from 20.6% in 2015, to 23.7 in 2016 and 29.7% in 2017, while antibiotic prescribing decreased from 30.3% to 28.0% and 26.7%, respectively (p&lt;0.05 in both cases). Practices located in high socioeconomic areas had higher ILI consultation rates (4.3 vs 2.5 per 1000 consultations, p&lt;0.05), antibiotic (30.7% vs 23.4%, p&lt;0.05) and antiviral (34.2% vs 13.5%, p&lt;0.05) prescribing than those in lower socioeconomic areas. The coexistence of chronic or mental health conditions was associated with lower ILI consultation rates, higher antibiotic use, but not with antiviral prescribing. However, those with chronic respiratory conditions had a higher frequency of antibiotic and antiviral prescribing in 2017 than individuals with other comorbidities.ConclusionsAlthough the apparent decline in antibiotic prescribing for ILI is welcome, the increase in antiviral use may not be targeting those at high risk of complications from infection.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>31048440</pmid><doi>10.1136/bmjopen-2018-026396</doi><orcidid>https://orcid.org/0000-0002-9018-0361</orcidid><orcidid>https://orcid.org/0000-0001-6998-6419</orcidid><orcidid>https://orcid.org/0000-0002-7153-2878</orcidid><oa>free_for_read</oa></addata></record>
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source BMJ journals single titles; BMJ Journals (Open Access); Publicly Available Content (ProQuest); PubMed Central
subjects Adolescent
Adult
Aged
Ambulatory care
Anti-Bacterial Agents - pharmacology
Antibiotics
Antiviral drugs
Australia - epidemiology
Child
Child, Preschool
Comorbidity
Databases, Factual
Drug Prescriptions - statistics & numerical data
Ethnicity
Female
General Practice - statistics & numerical data
General practice / Family practice
Humans
Illnesses
Incidence
Infections
Influenza
Influenza, Human - drug therapy
Influenza, Human - epidemiology
Longitudinal studies
Male
Medical records
Middle Aged
Patients
Pediatrics
Practice Patterns, Physicians
Primary care
Retrospective Studies
Sociodemographics
Young Adult
title Influenza-like illness and antimicrobial prescribing in Australian general practice from 2015 to 2017: a national longitudinal study using the MedicineInsight dataset
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