• Question: Do you think the reasons behind observed socio-economic gradients in antibiotic use in UK are due to morbidity only or partly due to differences in patient-prescriber behaviours?

    Asked by Anon on 15 Nov 2015.
    • Photo: Elizabeth Beech

      Elizabeth Beech answered on 16 Nov 2015:

      Hello Anon
      Antibiotic prescribing data for primary care shows large variation in both volume of use and proportion of broad spectrum antibiotic choices. This variation is seen at an NHS Area Team footprint in the Atlas of Variation maps, with highest consumption (shown as defined daily doses of antibiotics per day per 1000 population) in the North of England, and at the moment this has not to my knowledge been mapped against population based morbidity indicators, such as COPD. I understand PHE are looking at this approach. However, when you look at antibiotic prescribing data as number of prescription items per STAR-PU, at a CCG level there is large variability between CCGs who would be considered to have similar populations in terms of morbidity. There may be reasons such as access to health services out of usual hours that drive some of this variability, such as CCGs with a large rural geography compared to a CCG in inner London where the public can access antibiotics at a number of walk-in centres rather than GP practices. In addition people in rural areas may cash in a Back up prescription just in case, while people in towns may choose not to do so until they decide they do need the antibiotic. At the moment we do not collect this data, but when we start to this may provide some explanations. However, lastly when the same antibiotic prescribing indicator is reported at individual GP practice level, we see large variability between practices in the same CCG with similar morbidity and economic and geographical constraints. And so clearly patient -prescriber behaviours are influencing the use of antibiotics, and are very important as well. Cliodna can provide an answer on this aspect.

      And finally have a look at the heat map of antibiotic prescribing published by Antibiotic Research and linking to areas known to have deprivation – Clacton for a start.

    • Photo: Cliodna McNulty

      Cliodna McNulty answered on 17 Nov 2015:

      Yes in surveys of the public there is a difference of reported antibiotic use by social grade. those in social grades D and E have higher antibiotic use than social grades A and B. Antibiotic use is also related to educational level with those who have lno education beyond 16 years also having higher use. Interestingly these groups with higher are also less likely to say they have been given information about antibiotics last time they had an infection. so here is your chance to change behaviour and share information with patients when they next attend with an infection. If you can give a back up/delayed antibiotic instead of an immediate one then this will decrease future expectations for antibiotics and patients future consultations too!

    • Photo: Christopher Butler

      Christopher Butler answered on 18 Nov 2015:

      People who live is poor, over crowded housing and with poor nutrition are likely to get more infections and complications form infections. So yes to increased morbidity as one explanation. Expectations and habits do play an implant part in unnecessary prescribing as well.

    • Photo: Andrew Hayward

      Andrew Hayward answered on 18 Nov 2015:

      We have just been looking at data from a community cohort study of respiratory infections that shows that if you have a sore throat, your likelihood of consulting your GP and getting an antibiotic is driven mainly by the severity of the infection and there is no clear social class gradient. However, I think it likely that for antibiotic prescribing overall there will be an important relationship with levels of comorbidity which may drive social class variations in antibiotic use.