Financial incentives may cut antibiotic prescribing, with few unintended results

The antibiotic prescribing component of a financial incentive program to improve services at UK National Health Service (NHS) clinics found a significant reduction in both total and broad-spectrum antibiotic prescribing in primary care settings, with no link to unintended consequences, except for a few specific conditions.

A research team from Imperial College London reported its findings on Oct 18 in two separate reports in Clinical Infectious Diseases: one on the impact of the antimicrobial stewardship component of the Quality Premium (QP) program and the other on possible unintended consequences.

UK officials introduced the QP program in 2015, which included financial incentives for meeting different criteria, including reducing antibiotic prescribing by 1% and reducing broad-spectrum antibiotic prescriptions by 10%.

To gauge the impact of the program, the researchers analyzed national antibiotic prescribing data from April 2013 till February 2017 using a segmented regression analysis of interrupted time series data. They looked at the total number of items prescribed, the number prescribed per STAR-PU (specific therapeutic group age-sex related prescribing units), and number and percentage of broad-spectrum antibiotics prescribed.

More than 140 million antibiotic items were prescribed during the study period. After the quality premium was introduced, antibiotic prescribing decreased by 8.2%, reflecting more than 5.9 million fewer antibiotics prescribed in the 23 months after the QP went into effect compared with expected numbers based on trends found in the months before the intervention. The investigators also saw a relative decrease in antibiotics prescribed per STAR-PU, as well as a similar effect for broad-spectrum antibiotics, which were reduced by 18.9%.

Source: CIDRAP

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