Antibiotic prescribing in UK care homes 2016-2017:Retrospective cohort study of linked data

Abstract

Background: Older people living in care homes are particularly susceptible to infections and antibiotics are therefore used frequently for this population. However, there is limited information on antibiotic prescribing in this setting. This study aimed to investigate the frequency, patterns and risk factors for antibiotic prescribing in a large chain of UK care homes. Methods: Retrospective cohort study of administrative data from a large chain of UK care homes (resident and care home-level) linked to individual-level pharmacy data. Residents aged 65 years or older between 1 January 2016 and 31 December 2017 were included. Antibiotics were classified by type and as new or repeated prescriptions. Rates of antibiotic prescribing were calculated and modelled using multilevel negative binomial regression. Results: 13,487 residents of 135 homes were included. The median age was 85; 63% residents were female. 28,689 antibiotic prescriptions were dispensed, the majority were penicillins (11,327, 39%), sulfonamides and trimethoprim (5818, 20%), or other antibacterials (4665, 16%). 8433 (30%) were repeat prescriptions. The crude rate of antibiotic prescriptions was 2.68 per resident year (95% confidence interval (CI) 2.64-2.71). Increased antibiotic prescribing was associated with residents requiring more medical assistance (adjusted incidence rate ratio for nursing opposed to residential care 1.21, 95% CI 1.13-1.30). Prescribing rates varied widely by care home but there were no significant associations with the care home-level characteristics available in routine data. Conclusions: Rates of antibiotic prescribing in care homes are high and there is substantial variation between homes. Further research is needed to understand the drivers of this variation to enable development of effective stewardship approaches that target the influences of prescribing.

Publication DOI: https://doi.org/10.1186/s12913-020-05422-z
Divisions: Languages & Social Sciences > English
Additional Information: Funding Information: This work was supported by the Economic and Social Research Council, grant number ES/P008321/1, as part of the Preserving Antibiotics through Safe Stewardship (PASS) project. © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data
Uncontrolled Keywords: Anti-bacterial agents,Antibiotic prescribing,Antibiotic stewardship,care home,Infection,Long-term care,Older people,Health Policy
Full Text Link:
Related URLs: http://www.scop ... tnerID=8YFLogxK (Scopus URL)
https://bmcheal ... 913-020-05422-z (Publisher URL)
PURE Output Type: Article
Published Date: 2020-06-18
Accepted Date: 2020-06-10
Authors: Smith, Catherine M.
Williams, H.
Jhass, A.
Jhass, A.
Patel, Selina
Crayton, E.
Lorencatto, F.
Michie, S.
Hayward, Andrew C.
Shallcross, L. J.
Anderson, N.
Atkins, L.
Conolly, A.
Crayton, E.
Denaxas, S.
Dutey-Magni, P.
Elsay, N.
Forbes, G.
Fragaszy, E. B.
Freemantle, N.
Fuller, C.
Gill, M.
Hayward, A. H.
Horne, R.
Jhass, A.
Kostkova, P.
Lorencatto, F.
Michie, S.
Mindell, J.
Richardson, M.
Robson, J.
Rockenschaub, P.
Royston, C.
Shallcross, L. J.
Smith, C. M.
Sutton, E.
Thomas, J.
Tarrant, C.
Traina, R.
Richardson, E. (ORCID Profile 0000-0003-0399-2343)
West, J.
Williams, H.

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