Antibiotic Prescribing in Primary Care - Studying the Management of Infections using Real-World Data
Abstract
There is considerable variation in antibiotic prescribing rates among physicians, primary healthcare centres, and countries. If the variation could be reduced, the antibiotic prescribing could decrease.Methods. The thesis is based on real-world data from two databases containing infection visits: The Kronoberg Infection Database in Primary Care (infection visits in the Kronoberg region from 2006 to 2014) and the South Sweden Database (infection visits in four regions from 2018 to 2021). The statistical analyses include comparisons between groups using Chi-squared tests, binary logistic regression, and propensity score matching. The possibilities and hurdles of using real-world data are presented.Results. We found a general decline in antibiotic prescribing in spite of stable infection visits. The decline was more pronounced in children and in respiratory tract infections. No excess antibiotic prescribing during out-of-hours when adjusting for sex, age and diagnoses. No excess prescribing of broad-spectrum antibiotics during out-of-hours (Paper I). The use of point-of-care tests increased for acute bronchitis and pneumonia over a nine-year period. Also, the use of chest x-rays and microbiological tests increased, but remained at a low level (<5 %). Fewer antibiotics were prescribed in acute bronchitis (Paper II). Most physicians reduced their antibiotic prescribing over a nine-year period. Nine out of ten low prescribers remained low prescribers. Interpretation of diagnostic…
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