Trends and patterns in antibiotic prescribing among out-of-hours primary care providers in England, 2010–14

Objectives: Antimicrobial resistance is a global threat, increasing morbidity and mortality. In England, publicly funded clinical commissioning groups (CCGs) commission out-of-hours (OOH) primary care services outside daytime hours. OOH consultations represent 1% of in-hours general practice (GP) consultations. Antibiotic prescriptions increased 32% in non-GP community services between 2010 and 2013. We describe OOH antibiotic prescribing patterns and trends between 2010 and 2014. Methods: We: estimated the proportion of CCGs with OOH data available; described and compared antibiotic prescribing by volume of prescribed items, seasonality and trends in GP and OOH, using linear regression; and compared the proportion of broad-spectrum to total antibiotic prescriptions in OOHs with their respective CCGs in terms of seasonality and trends, using binomial regression. Results: Data were available for 143 of 211 (68%) CCGs. OOH antibiotic prescription volume represented 4.5%-5.4% of GP prescription volume and was stable over time ( P  =   0.37). The proportion of broad-spectrum antibiotic prescriptions increased in OOH when it increased in the CCG they operated in (regression coefficient 0.98; 95% CI 0.96-0.99). Compared with GP, the proportion of broad-spectrum antibiotic prescriptions in OOH was higher but decreased both in GP and OOH (-0.57%, 95% CI - 0.54% to - 0.6% and -0.76%, 95% CI - 0.59% to - 0.93% per year, respectively). Conclusions: OOH proportionally prescribed more antibiotics than GPs although we could not comment on prescribing appropriateness. OOH prescribing volume was stable over time, and followed GP seasonal patterns. OOH antibiotic prescribing reflected the CCGs they operated in but with relatively more broad-spectrum antibiotics than in-hours GP. Understanding factors influencing prescribing in OOH will enable the development of tailored interventions promoting optimal prescribing in this setting

Media 3: Incorporation of an experimentally determined MTF for spatial frequency filtering and deconvolution during optical projection tomography reconstruction

Originally published in Optics Express on 26 March 2012 (oe-20-7-7323

Media 5: In vivo fluorescence lifetime optical projection tomography

Originally published in Biomedical Optics Express on 01 May 2011 (boe-2-5-1340

Media 4: In vivo fluorescence lifetime optical projection tomography

Originally published in Biomedical Optics Express on 01 May 2011 (boe-2-5-1340

Media 6: In vivo fluorescence lifetime optical projection tomography

Originally published in Biomedical Optics Express on 01 May 2011 (boe-2-5-1340

Media 4: Incorporation of an experimentally determined MTF for spatial frequency filtering and deconvolution during optical projection tomography reconstruction

Originally published in Optics Express on 26 March 2012 (oe-20-7-7323

Media 2: Incorporation of an experimentally determined MTF for spatial frequency filtering and deconvolution during optical projection tomography reconstruction

Originally published in Optics Express on 26 March 2012 (oe-20-7-7323

Media 1: In vivo fluorescence lifetime optical projection tomography

Originally published in Biomedical Optics Express on 01 May 2011 (boe-2-5-1340

Media 2: In vivo fluorescence lifetime optical projection tomography

Originally published in Biomedical Optics Express on 01 May 2011 (boe-2-5-1340