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Publication - Dr Esther Van der Werf-Kok

    Do NHS GP surgeries employing GPs additionally trained in Integrative or Complementary Medicine have lower antibiotic prescribing rates? Retrospective cross-sectional analysis of national primary care prescribing data in England in 2016

    Citation

    Werf-Kok, Evd, Duncan, L, von Flotow, P & Baars, E, 2018, ‘Do NHS GP surgeries employing GPs additionally trained in Integrative or Complementary Medicine have lower antibiotic prescribing rates? Retrospective cross-sectional analysis of national primary care prescribing data in England in 2016’. BMJ Open, vol 8.

    Abstract

    Objective
    To determine differences in antibiotic prescription rates between conventional General Practice (GP) surgeries and GP surgeries employing General Practitioners (GPs) additionally trained in Integrative Medicine (IM) or Complementary and Alternative Medicine (CAM) (referred to as IM GPs) working within NHS England.
    Design
    Retrospective study on antibiotic prescription rates per STAR-PU (Specific Therapeutic group Age-sex weighting Related Prescribing Unit) using NHS digital data over 2016. Publicly available data were used on prevalence of relevant comorbidities, demographics of patient populations and deprivation scores.
    Setting
    Primary Care
    Participants
    7283 NHS GP surgeries in England
    Primary outcome measure
    The association between IM GPs and antibiotic prescribing rates per STAR-PU with the number of antibiotic prescriptions (total, and for respiratory- and urinary tract infection separately (RTI/UTI)) as outcome.
    Results
    IM GPs (N=9) were comparable to conventional GPs in terms of list sizes, demographics, deprivation scores and comorbidity prevalence. A negative binomial regression models showed that statistically significantly fewer total antibiotics (RR: 0.78, 95% CI:0.64 – 0.97) and RTI antibiotics (RR 0.74, 95% CI: 0.59 – 0.94) were prescribed at NHS IM GP surgeries compared with conventional NHS GP surgeries. In contrast, the number of antibiotics prescribed for UTI were similar between both practices (RR: 0.91, 95% CI: 0.72 – 1.17).
    Conclusion
    NHS England GP surgeries employing GPs additionally trained in Integrative or Complementary Medicine have lower antibiotic prescribing rates. Accessibility of IM/CAM within NHS England primary care is limited. Main study limitation is the lack of consultation data. Future research should include the differences in consultation behaviour of patients self-selecting to consult a IM GP or conventional surgery, and its effect on antibiotic prescription. Additional treatment strategies for common primary care infections used by IM GPs should be explored to see if they could be used to assist in the fight against AMR.

    Full details in the University publications repository