{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T10:22:40Z","timestamp":1772792560403,"version":"3.50.1"},"reference-count":39,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2022,3,3]],"date-time":"2022-03-03T00:00:00Z","timestamp":1646265600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002141","name":"Public Health England","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002141","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Connected Health Cities Department of Health"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Qual Saf"],"accepted":{"date-parts":[[2022,2,2]]},"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>There is a need to reduce antimicrobial uses in humans. Previous studies have found variations in antibiotic (AB) prescribing between practices in primary care. This study assessed variability of AB prescribing between clinicians.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Clinical Practice Research Datalink, which collects electronic health records in primary care, was used to select anonymised clinicians providing 500+ consultations during 2012\u20132017. Eight measures of AB prescribing were assessed, such as overall and incidental AB prescribing, repeat AB courses and extent of risk-based prescribing. Poisson regression models with random effect for clinicians were fitted.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>6111 clinicians from 466 general practices were included. Considerable variability between individual clinicians was found for most AB measures. For example, the rate of AB prescribing varied between 77.4 and 350.3 per 1000 consultations; percentage of repeat AB courses within 30 days ranged from 13.1% to 34.3%; predicted patient risk of hospital admission for infection-related complications in those prescribed AB ranged from 0.03% to 0.32% (5th and 95th percentiles). The adjusted relative rate between clinicians in rates of AB prescribing was 5.23. Weak correlation coefficients (&lt;0.5) were found between most AB measures. There was considerable variability in case mix seen by clinicians. The largest potential impact to reduce AB prescribing could be around encouraging risk-based prescribing and addressing repeat issues of ABs. Reduction of repeat AB courses to prescribing habit of median clinician would save 21 813 AB prescriptions per 1000 clinicians per year.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The wide variation seen in all measures of AB prescribing and weak correlation between them suggests that a single AB measure, such as prescribing rate, is not sufficient to underpin the optimisation of AB prescribing.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjqs-2020-012108","type":"journal-article","created":{"date-parts":[[2022,3,3]],"date-time":"2022-03-03T13:25:35Z","timestamp":1646313935000},"page":"831-838","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Comparing antibiotic prescribing between clinicians in UK primary care: an analysis in a cohort study of eight different measures of antibiotic prescribing"],"prefix":"10.1136","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9363-742X","authenticated-orcid":false,"given":"Tjeerd","family":"Van Staa","sequence":"first","affiliation":[{"name":"Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Li","sequence":"additional","affiliation":[{"name":"Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natalie","family":"Gold","sequence":"additional","affiliation":[{"name":"Behavioural Insights and Evaluation, Public Health England, London, UK"},{"name":"Centre for Philosophy of Natural and Social Science, London School of Economics and Political Science, London, England"},{"name":"Behavioural Practice, Kantar Public, London, England"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tim","family":"Chadborn","sequence":"additional","affiliation":[{"name":"Behavioural Insights and Evaluation, Public Health England, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William","family":"Welfare","sequence":"additional","affiliation":[{"name":"North West Health Protection Team, Public Health England North West, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victoria","family":"Palin","sequence":"additional","affiliation":[{"name":"Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Darren M","family":"Ashcroft","sequence":"additional","affiliation":[{"name":"Centre for Pharmacoepidemiology and Drug Safety and NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joanna","family":"Bircher","sequence":"additional","affiliation":[{"name":"Lockside Medical Centre, Stalybridge, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,3,3]]},"reference":[{"key":"2025090410192900000_31.11.831.1","unstructured":"English surveillance programme for antimicrobial utilisation and resistance (ESPAUR), 2018. Available: https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/759975\/ESPAUR_2018_report.pdf [Accessed 10 Feb 2019]."},{"key":"2025090410192900000_31.11.831.2","unstructured":"O\u2019Neill J on behalf of the Review on Antimicrobial Resistance . Tackling drug resistant-infection globally: final report and recommendations. Available: https:\/\/amr-review.org\/sites\/default\/files\/160518_Final paper_with cover.pdf [Accessed 8 Mar 2018]."},{"key":"2025090410192900000_31.11.831.3","unstructured":"NHS England, quality premium. Available: https:\/\/www.england.nhs.uk\/ccg-out-tool\/qual-prem\/ [Accessed 10 Feb 2019]."},{"key":"2025090410192900000_31.11.831.4","unstructured":"Target antibiotic toolkit. Available: https:\/\/www.rcgp.org.uk\/TARGETantibiotics [Accessed 10 Feb 2019]."},{"key":"2025090410192900000_31.11.831.5","unstructured":"The UK\u2019s five-year national action plan, 2019. Available: https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/784894\/UK_AMR_5_year_national_action_plan.pdf [Accessed 16 Mar 2019]."},{"key":"2025090410192900000_31.11.831.6","unstructured":"Improving people\u2019s health: Applying behavioural and social sciences to improve population health and wellbeing in England, 2018. Available: https:\/\/www.facebook.com\/PublicHealthEngland [Accessed 1 Feb 2020]."},{"key":"2025090410192900000_31.11.831.7","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.0275"},{"key":"2025090410192900000_31.11.831.8","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)00215-4"},{"key":"2025090410192900000_31.11.831.9","unstructured":"Pinder P , Sallis A , Berry D . Behaviour change and antibiotic prescribing in healthcare settings literature review and behavioural analysis, 2015. Available: https:\/\/www.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/405031\/Behaviour_Change_for_Antibiotic_Prescribing_-_FINAL.pdf"},{"key":"2025090410192900000_31.11.831.10","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2015-008270","article-title":"Bad apples or spoiled barrels? multilevel modelling analysis of variation in high-risk prescribing in Scotland between general practitioners and between the practices they work in","volume":"5","author":"Guthrie","year":"2015","journal-title":"BMJ Open"},{"key":"2025090410192900000_31.11.831.11","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyv098"},{"key":"2025090410192900000_31.11.831.12","unstructured":"ePACT2 guide how to use standard, Astro and StAR pus contents. Available: https:\/\/www.nhsbsa.nhs.uk\/sites\/default\/files\/2019-03\/ePACT2 - Using Patient Unit Measures %28ASTRO%2BStandard%2BSTAR PU%29 Columns v2.pdf[Accessed 3 Jun 2020]."},{"key":"2025090410192900000_31.11.831.13","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-020-1504-5"},{"key":"2025090410192900000_31.11.831.14","doi-asserted-by":"crossref","DOI":"10.1186\/s12916-020-01581-2","article-title":"Development and validation of a multivariable prediction model for infection-related complications in patients with common infections in UK primary care and the extent of risk-based prescribing of antibiotics","volume":"18","author":"Mistry","year":"2020","journal-title":"BMC Med"},{"key":"2025090410192900000_31.11.831.15","doi-asserted-by":"publisher","DOI":"10.1111\/ijcp.12142"},{"key":"2025090410192900000_31.11.831.16","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2017-007737"},{"key":"2025090410192900000_31.11.831.17","unstructured":"Schabenberger O . Introducing the GLIMMIX procedure for generalized linear mixed models. Available: https:\/\/support.sas.com\/resources\/papers\/proceedings\/proceedings\/sugi30\/196-30.pdf [Accessed 25 Feb 2021]."},{"key":"2025090410192900000_31.11.831.18","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp17X693077"},{"key":"2025090410192900000_31.11.831.19","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2017-209195"},{"key":"2025090410192900000_31.11.831.20","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.healthplace.2018.07.004","article-title":"Antibiotic prescribing patterns in general medical practices in England: does area matter?","volume":"53","author":"M\u00f6lter","year":"2018","journal-title":"Health Place"},{"key":"2025090410192900000_31.11.831.21","doi-asserted-by":"crossref","unstructured":"Palin V , Tempest E , Mistry C . Developing the infrastructure to support the optimisation of antibiotic prescribing using the learning healthcare system. BMJ Heal Care Informatics 2020;27.","DOI":"10.1136\/bmjhci-2020-100147"},{"key":"2025090410192900000_31.11.831.22","unstructured":"NHS England . Sustainable improvement team and the horizons team leading large scale change. Available: https:\/\/www.england.nhs.uk\/wp-content\/uploads\/2017\/09\/practical-guide-large-scale-change-april-2018-smll.pdf [Accessed 23 Nov 2019]."},{"key":"2025090410192900000_31.11.831.23","doi-asserted-by":"crossref","DOI":"10.1136\/bmjhci-2020-100147","article-title":"Developing the infrastructure to support the optimisation of antibiotic prescribing using the learning healthcare system to improve healthcare services in the provision of primary care in England","volume":"27","author":"Palin","year":"2020","journal-title":"BMJ Health Care Inform"},{"key":"2025090410192900000_31.11.831.24","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.13739"},{"key":"2025090410192900000_31.11.831.25","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1038\/s41591-019-0503-6","article-title":"Personal clinical history predicts antibiotic resistance of urinary tract infections","volume":"25","author":"Yelin","year":"2019","journal-title":"Nat Med"},{"key":"2025090410192900000_31.11.831.26","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i3410"},{"key":"2025090410192900000_31.11.831.27","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-041218","article-title":"Infection-related complications and hospitalisations after common infections are influenced by the level of incidental antibiotic prescribing in primary care","volume":"11","author":"van Bodegraven","year":"2021","journal-title":"BMJ Open"},{"key":"2025090410192900000_31.11.831.28","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2466-13-32","article-title":"Variability of antibiotic prescribing in patients with chronic obstructive pulmonary disease exacerbations: a cohort study","volume":"13","author":"Boggon","year":"2013","journal-title":"BMC Pulm Med"},{"key":"2025090410192900000_31.11.831.29","doi-asserted-by":"crossref","first-page":"3371","DOI":"10.1093\/jac\/dkz345","article-title":"Adherence to antibiotic prescribing guidelines \u2013 rates and drivers of inappropriate prescribing in UK general practices","volume":"74","author":"Nowakowska","year":"2019","journal-title":"J Antimicrob Chemother"},{"key":"2025090410192900000_31.11.831.30","doi-asserted-by":"crossref","first-page":"2440","DOI":"10.1093\/jac\/dkz163","article-title":"Antibiotic prescribing for common infections in UK general practice: variability and drivers","volume":"74","author":"Palin","year":"2019","journal-title":"J Antimicrob Chemother"},{"key":"2025090410192900000_31.11.831.31","unstructured":"National Institute of Health and Care Excellence . Overview | respiratory tract infections (self-limiting): prescribing antibiotics | guidance | NICE. Available: https:\/\/www.nice.org.uk\/guidance\/cg69 [Accessed 30 May 2019]."},{"key":"2025090410192900000_31.11.831.32","unstructured":"Recommendations | urinary tract infection (lower): antimicrobial prescribing | guidance | NICE. Available: https:\/\/www.nice.org.uk\/guidance\/ng109\/chapter\/Recommendations#reassessment [Accessed 6 Mar 2019]."},{"key":"2025090410192900000_31.11.831.33","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g5493"},{"key":"2025090410192900000_31.11.831.34","doi-asserted-by":"crossref","first-page":"942","DOI":"10.1186\/s12913-019-4787-5","article-title":"The role of real-world data in the development of treatment guidelines: a case study on guideline developers\u2019 opinions about using observational data on antibiotic prescribing in primary care","volume":"19","author":"Steels","year":"2019","journal-title":"BMC Health Serv Res"},{"key":"2025090410192900000_31.11.831.35","unstructured":"National Institute for Health and Care Excellence (NICE) . Respiratory tract infections (self-limiting): prescribing antibiotics (CG 69), 2018."},{"key":"2025090410192900000_31.11.831.36","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39609.449676.25"},{"key":"2025090410192900000_31.11.831.37","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-015-0224-y"},{"key":"2025090410192900000_31.11.831.38","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkz410"},{"key":"2025090410192900000_31.11.831.39","doi-asserted-by":"crossref","DOI":"10.1186\/s12875-019-1065-x","article-title":"General practitioners' accounts of negotiating antibiotic prescribing decisions with patients: a qualitative study on what influences antibiotic prescribing in low, medium and high prescribing practices","volume":"20","author":"van der Zande","year":"2019","journal-title":"BMC Fam Pract"}],"container-title":["BMJ Quality &amp; Safety"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjqs-2020-012108","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T17:19:42Z","timestamp":1757006382000},"score":1,"resource":{"primary":{"URL":"https:\/\/qualitysafety.bmj.com\/lookup\/doi\/10.1136\/bmjqs-2020-012108"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,3]]},"references-count":39,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,10,19]]},"published-print":{"date-parts":[[2022,11]]}},"alternative-id":["10.1136\/bmjqs-2020-012108"],"URL":"https:\/\/doi.org\/10.1136\/bmjqs-2020-012108","relation":{},"ISSN":["2044-5415","2044-5423"],"issn-type":[{"value":"2044-5415","type":"print"},{"value":"2044-5423","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,3]]}}}