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

Catherine M. Smith; H. Williams; A. Jhass; A. Jhass; Selina Patel; E. Crayton; F. Lorencatto; S. Michie; Andrew C. Hayward; L. J. Shallcross; N. Anderson; L. Atkins; A. Conolly; E. Crayton; S. Denaxas; P. Dutey-Magni; N. Elsay; G. Forbes; E. B. Fragaszy; N. Freemantle; C. Fuller; M. Gill; A. H. Hayward; R. Horne; A. Jhass; P. Kostkova; F. Lorencatto; S. Michie; J. Mindell; M. Richardson; J. Robson; P. Rockenschaub; C. Royston; L. J. Shallcross; C. M. Smith; E. Sutton; J. Thomas; C. Tarrant; R. Traina; E. Richardson; J. West; H. Williams

doi:10.1186/s12913-020-05422-z

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

Catherine M. Smith, H. Williams, A. Jhass, A. Jhass, Selina Patel, E. Crayton, F. Lorencatto, S. Michie, Andrew C. Hayward, L. J. Shallcross, N. Anderson, L. Atkins, A. Conolly, E. Crayton, S. Denaxas, P. Dutey-Magni, N. Elsay, G. Forbes, E. B. Fragaszy, N. FreemantleC. Fuller, M. Gill, A. H. Hayward, R. Horne, A. Jhass, P. Kostkova, F. Lorencatto, S. Michie, J. Mindell, M. Richardson, J. Robson, P. Rockenschaub, C. Royston, L. J. Shallcross, C. M. Smith, E. Sutton, J. Thomas, C. Tarrant, R. Traina, E. Richardson, J. West, H. Williams

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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.

Original language	English
Article number	555
Journal	BMC Health Services Research
Volume	20
Issue number	1
DOIs	https://doi.org/10.1186/s12913-020-05422-z
Publication status	Published - 18 Jun 2020

Bibliographical note

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

Keywords

Anti-bacterial agents
Antibiotic prescribing
Antibiotic stewardship
care home
Infection
Long-term care
Older people

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10.1186/s12913-020-05422-zLicence: CC BY 3.0

Antibiotic prescribing in UK care homes 2016–2017: retrospective cohort study of linked data
© 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. 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
Final published version, 718 KBLicence: CC BY 3.0

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Smith, C. M., Williams, H., Jhass, A., Jhass, A., Patel, S., Crayton, E., Lorencatto, F., Michie, S., Hayward, A. C., Shallcross, L. J., Anderson, N., Atkins, L., Conolly, A., Crayton, E., Denaxas, S., Dutey-Magni, P., Elsay, N., Forbes, G., Fragaszy, E. B., ... Williams, H. (2020). Antibiotic prescribing in UK care homes 2016-2017: Retrospective cohort study of linked data. BMC Health Services Research, 20(1), Article 555. https://doi.org/10.1186/s12913-020-05422-z

@article{e3f053cf38e14214965d91d5190095f5,

title = "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. ",

keywords = "Anti-bacterial agents, Antibiotic prescribing, Antibiotic stewardship, care home, Infection, Long-term care, Older people",

author = "Smith, {Catherine M.} and H. Williams and A. Jhass and A. Jhass and Selina Patel and E. Crayton and F. Lorencatto and S. Michie and Hayward, {Andrew C.} and Shallcross, {L. J.} and N. Anderson and L. Atkins and A. Conolly and E. Crayton and S. Denaxas and P. Dutey-Magni and N. Elsay and G. Forbes and Fragaszy, {E. B.} and N. Freemantle and C. Fuller and M. Gill and Hayward, {A. H.} and R. Horne and A. Jhass and P. Kostkova and F. Lorencatto and S. Michie and J. Mindell and M. Richardson and J. Robson and P. Rockenschaub and C. Royston and Shallcross, {L. J.} and Smith, {C. M.} and E. Sutton and J. Thomas and C. Tarrant and R. Traina and E. Richardson and J. West and H. Williams",

note = "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. {\textcopyright} 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",

year = "2020",

month = jun,

day = "18",

doi = "10.1186/s12913-020-05422-z",

language = "English",

volume = "20",

journal = "BMC Health Services Research",

issn = "1472-6963",

publisher = "BioMed Central",

number = "1",

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Smith, CM, Williams, H, Jhass, A, Jhass, A, Patel, S, Crayton, E, Lorencatto, F, Michie, S, Hayward, AC, Shallcross, LJ, Anderson, N, Atkins, L, Conolly, A, Crayton, E, Denaxas, S, Dutey-Magni, P, Elsay, N, Forbes, G, Fragaszy, EB, Freemantle, N, Fuller, C, Gill, M, Hayward, AH, Horne, R, Jhass, A, Kostkova, P, Lorencatto, F, Michie, S, Mindell, J, Richardson, M, Robson, J, Rockenschaub, P, Royston, C, Shallcross, LJ, Smith, CM, Sutton, E, Thomas, J, Tarrant, C, Traina, R, Richardson, E, West, J & Williams, H 2020, 'Antibiotic prescribing in UK care homes 2016-2017: Retrospective cohort study of linked data', BMC Health Services Research, vol. 20, no. 1, 555. https://doi.org/10.1186/s12913-020-05422-z

TY - JOUR

T1 - Antibiotic prescribing in UK care homes 2016-2017

T2 - Retrospective cohort study of linked data

AU - Smith, Catherine M.

AU - Williams, H.

AU - Jhass, A.

AU - Patel, Selina

AU - Crayton, E.

AU - Lorencatto, F.

AU - Michie, S.

AU - Hayward, Andrew C.

AU - Shallcross, L. J.

AU - Anderson, N.

AU - Atkins, L.

AU - Conolly, A.

AU - Crayton, E.

AU - Denaxas, S.

AU - Dutey-Magni, P.

AU - Elsay, N.

AU - Forbes, G.

AU - Fragaszy, E. B.

AU - Freemantle, N.

AU - Fuller, C.

AU - Gill, M.

AU - Hayward, A. H.

AU - Horne, R.

AU - Jhass, A.

AU - Kostkova, P.

AU - Lorencatto, F.

AU - Michie, S.

AU - Mindell, J.

AU - Richardson, M.

AU - Robson, J.

AU - Rockenschaub, P.

AU - Royston, C.

AU - Shallcross, L. J.

AU - Smith, C. M.

AU - Sutton, E.

AU - Thomas, J.

AU - Tarrant, C.

AU - Traina, R.

AU - Richardson, E.

AU - West, J.

AU - Williams, H.

N1 - 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

PY - 2020/6/18

Y1 - 2020/6/18

N2 - 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.

AB - 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.

KW - Anti-bacterial agents

KW - Antibiotic prescribing

KW - Antibiotic stewardship

KW - care home

KW - Infection

KW - Long-term care

KW - Older people

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UR - https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05422-z

U2 - 10.1186/s12913-020-05422-z

DO - 10.1186/s12913-020-05422-z

M3 - Article

C2 - 32552886

AN - SCOPUS:85086694080

SN - 1472-6963

VL - 20

JO - BMC Health Services Research

JF - BMC Health Services Research

IS - 1

M1 - 555

ER -

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

Abstract

Bibliographical note

Keywords

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How does organisational context impact on antibiotic stewardship in primary care?

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