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After-hours consultations and antibiotic prescribing for self-limiting upper respiratory tract infections in primary-care practices

Published online by Cambridge University Press:  07 July 2022

Zhuoxin Peng ,
Wen-Qiang He ,
Andrew Hayen ,
John Hall Open the ORCID record for John Hall [Opens in a new window]  and
Bette Liu
Zhuoxin Peng*
Affiliation:
School of Population Health, University of New South Wales, Kensington, New South Wales, Australia Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
Wen-Qiang He
Affiliation:
School of Population Health, University of New South Wales, Kensington, New South Wales, Australia
Andrew Hayen
Affiliation:
School of Public Health, University of Technology Sydney, Ultimo, New South Wales, Australia
John Hall
Affiliation:
School of Population Health, University of New South Wales, Kensington, New South Wales, Australia
Bette Liu
Affiliation:
School of Population Health, University of New South Wales, Kensington, New South Wales, Australia
*
Author for correspondence: Zhuoxin Peng, School of Population Health, University of New South Wales, High St, Kensington, New South Wales, 2052 Australia. E-mail: zhuoxinp@gmail.com
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Abstract

Objectives:

To determine the association between after-hours consultations and the likelihood of antibiotic prescribing for self-limiting upper respiratory tract infections (URTIs) in primary care practices.

Design:

A cross-sectional analysis using Australian national primary-care practice data (MedicineInsight) between February 1, 2016 and January 31, 2019.

Setting:

Nationwide primary-care practices across Australia.

Participants:

Adult and pediatric patients who visited primary care practices for first-time URTIs.

Methods:

We estimated the proportion of first-time URTI episodes for which antibiotic prescribing occurred on the same day (immediate prescribing) using diagnoses and prescription records in the electronic primary-care database. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the likelihood of antibiotic prescribing by the time of primary care visits were calculated using generalized estimating equations.

Results:

Among 357,287 URTI episodes, antibiotics were prescribed in 172,605 episodes (48.3%). After adjusting for patients’ demographics, practice characteristics, and seasons, we detected a higher likelihood of antibiotic prescribing on weekends compared to weekdays (OR, 1.42; 95% CI, 1.39–1.45) and on national public holidays compared to nonholidays (OR, 1.23; 95% CI, 1.17–1.29). When we controlled for patient presentation and diagnosis, the association between antibiotic prescribing and after-hours consultations remained significant: weekend versus weekdays (OR, 1.37; 95% CI, 1.33–1.41) and holidays versus nonholidays (OR, 1.10; 95% CI, 1.03–1.18).

Conclusions:

Primary-care consultations on weekends and public holidays were associated with a higher likelihood of immediate antibiotic prescribing for self-limiting URTIs in primary care. This finding might be attributed to lower resourcing in after-hours health care.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 44 , Issue 5 , May 2023 , pp. 755 - 761
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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