{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T07:11:15Z","timestamp":1765609875322,"version":"3.37.3"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2018,10,18]],"date-time":"2018-10-18T00:00:00Z","timestamp":1539820800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"National Institute for Health Research (NIHR) Policy Research Programme"},{"name":"Health Protection Research Unit"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,7,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The \u201cQuality Premium\u201d (QP) introduced in England in 2015 aimed to financially reward local healthcare commissioners for targeted reductions in primary care antibiotic prescribing. We aimed to evaluate possible unintended clinical outcomes related to this QP.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Using Clinical Practice Research Datalink and Hospital Episode Statistics datasets, we examined general practitioner (GP) consultations (visits) and emergency hospital admissions related to a series of predefined conditions of unintended consequences of reduced prescribing. Monthly age- and sex-standardized rates were calculated using a direct method of standardization. We used segmented regression analysis of interrupted time series to evaluate the impact of the QP on seasonally adjusted outcome rates.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We identified 27334 GP consultations and &gt;5 million emergency hospital admissions with predefined conditions. There was no evidence that the QP was associated with changes in GP consultation and hospital admission rates for the selected conditions combined. However, when each condition was considered separately, a significant increase in hospital admission rates was noted for quinsy, and significant decreases were seen for hospital-acquired pneumonia, scarlet fever, pyelonephritis, and complicated urinary tract conditions. A significant decrease in GP consultation rates was estimated for empyema and scarlet fever. No significant changes were observed for other conditions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Findings from this study show that overall there was no significant association between the intervention and unintended clinical consequences, with the exception of a few specific conditions, most of which could be explained through other parallel policy changes or should be interpreted with caution due to small numbers.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciy904","type":"journal-article","created":{"date-parts":[[2018,10,15]],"date-time":"2018-10-15T15:12:43Z","timestamp":1539616363000},"page":"233-242","source":"Crossref","is-referenced-by-count":17,"title":["An Assessment of Potential Unintended Consequences Following a National Antimicrobial Stewardship Program in England: An Interrupted Time Series Analysis"],"prefix":"10.1093","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3195-8820","authenticated-orcid":false,"given":"Violeta","family":"Balinskaite","sequence":"first","affiliation":[{"name":"Dr Foster Unit, Department of Primary Care and Public Health, London, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sabine","family":"Bou-Antoun","sequence":"additional","affiliation":[{"name":"Department of Primary Care and Public Health, London, United Kingdom"},{"name":"Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, National Institute for Health Research, Imperial College London, London, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan P","family":"Johnson","sequence":"additional","affiliation":[{"name":"Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, National Institute for Health Research, Imperial College London, London, United Kingdom"},{"name":"National Infection Service, Public Health England, London, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alison","family":"Holmes","sequence":"additional","affiliation":[{"name":"Department of Primary Care and Public Health, London, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Aylin","sequence":"additional","affiliation":[{"name":"Dr Foster Unit, Department of Primary Care and Public Health, London, United Kingdom"},{"name":"Department of Primary Care and Public Health, London, United Kingdom"},{"name":"Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, National Institute for Health Research, Imperial College London, London, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2018,10,18]]},"reference":[{"year":"2015","author":"O\u2019Neill","article-title":"Securing new drugs for future generations: the pipeline of antibiotics. 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Pay-for-performance and the quality of healthcare providers","volume":"41","author":"Mullen","year":"2010","journal-title":"Rand J Econ"},{"key":"2019070201025925800_CIT0004","doi-asserted-by":"crossref","first-page":"e39","DOI":"10.1002\/hec.3535","article-title":"Can pay-for-performance to primary care providers stimulate appropriate use of antibiotics","volume":"27","author":"Elleg\u00e5rd","year":"2018","journal-title":"Health Economics"},{"author":"Bou-Antoun","journal-title":"J Antimicrob Chemother","article-title":"Age-related decline in antibiotic prescribing for uncomplicated respiratory tract conditions in primary care in England following the introduction of a national financial incentive (the Quality Premium) for health commissioners to reduce use of antibiotics in the community: an interrupted time series analysis","key":"2019070201025925800_CIT0005"},{"key":"2019070201025925800_CIT0006","doi-asserted-by":"crossref","first-page":"d8173","DOI":"10.1136\/bmj.d8173","article-title":"Effectiveness of multifaceted educational programme to reduce antibiotic dispensing in primary care: practice based randomised controlled trial","volume":"344","author":"Butler","year":"2012","journal-title":"BMJ"},{"key":"2019070201025925800_CIT0007","doi-asserted-by":"crossref","first-page":"2345","DOI":"10.1001\/jama.2013.6287","article-title":"Effect of an outpatient antimicrobial stewardship intervention on broad-spectrum antibiotic prescribing by primary care pediatricians: a randomized trial","volume":"309","author":"Gerber","year":"2013","journal-title":"JAMA"},{"key":"2019070201025925800_CIT0008","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1001\/jamainternmed.2016.8040","article-title":"Personalized prescription feedback using routinely collected data to reduce antibiotic use in primary care: a randomized clinical trial","volume":"177","author":"Hemkens","year":"2017","journal-title":"JAMA Intern Med"},{"key":"2019070201025925800_CIT0009","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/S1473-3099(08)70017-3","article-title":"Sustained reduction of antibiotic use and low bacterial resistance: 10-year follow-up of the Swedish Strama programme","volume":"8","author":"M\u00f6lstad","year":"2008","journal-title":"Lancet Infect Dis"},{"key":"2019070201025925800_CIT0010","doi-asserted-by":"crossref","first-page":"e801","DOI":"10.3399\/bjgp12X659268","article-title":"Effectiveness of physician-targeted interventions to improve antibiotic use for respiratory tract infections","volume":"62","author":"van der Velden","year":"2012","journal-title":"Br J Gen Pract"},{"key":"2019070201025925800_CIT0011","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/S0140-6736(85)91094-3","article-title":"Management of a restricted drugs policy in hospital: the first five years\u2019 experience","volume":"1","author":"Collier","year":"1985","journal-title":"Lancet"},{"volume-title":"Prescriptions dispensed in the community, statistics for England: 2002\u20132012","author":"National Health Service Digital","key":"2019070201025925800_CIT0012"},{"author":"National Health Service England","key":"2019070201025925800_CIT0013"},{"key":"2019070201025925800_CIT0014","doi-asserted-by":"crossref","first-page":"i3410","DOI":"10.1136\/bmj.i3410","article-title":"Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records","volume":"354","author":"Gulliford","year":"2016","journal-title":"BMJ"},{"key":"2019070201025925800_CIT0015","doi-asserted-by":"crossref","first-page":"54","DOI":"10.3399\/bjgp15X683353","article-title":"The CPRD and the RCGP: building on research success by enhancing benefits for patients and practices","volume":"65","author":"Kousoulis","year":"2015","journal-title":"Br J Gen Pract"},{"key":"2019070201025925800_CIT0016","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1592\/phco.23.5.686.32205","article-title":"Validity of the general practice research database","volume":"23","author":"Jick","year":"2003","journal-title":"Pharmacotherapy"},{"key":"2019070201025925800_CIT0017","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1093\/ije\/dyv098","article-title":"Data resource profile: Clinical Practice Research Datalink (CPRD)","volume":"44","author":"Herrett","year":"2015","journal-title":"Int J Epidemiol"},{"volume-title":"Clinical commissioning groups. 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