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  • 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

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General practice / Family practice
Research
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
  1. Esther T van der Werf1,
  2. Lorna J Duncan1,
  3. Paschen von Flotow2,
  4. Erik W Baars3,4
  1. 1 Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
  2. 2 Sustainable Business Institute (SBI), Oestrich-Winkel, Germany
  3. 3 Louis Bolk Institute, Bunnik, The Netherlands
  4. 4 University of Applied Sciences, Leiden, The Netherlands
  1. Correspondence to Dr Esther T van der Werf; esther.vanderwerf{at}bristol.ac.uk

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 National Health Service (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 tract infection (RTI) and urinary tract infection (UTI) separately) as outcome.

Results IM GP surgeries (n=9) were comparable to conventional GP surgeries in terms of list sizes, demographics, deprivation scores and comorbidity prevalence. Negative binomial regression models showed that statistically significant fewer total antibiotics (relative risk (RR) 0.78, 95% CI 0.64 to 0.97) and RTI antibiotics (RR 0.74, 95% CI 0.59 to 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.

Conclusion NHS England GP surgeries employing GPs additionally trained in IM/CAM 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 an 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 antimicrobial resistance.

  • antimicrobial resistance
  • complementary medicine
  • integrative medicine
  • antibiotic prescription rate

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2017-020488

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    Footnotes

    • Contributors Substantial contributions to the conception and design of the work: ETvdW/LJD/PvF/EWB. Acquisition, analysis or interpretation of data for the work: ETvdW/LJD. Drafting the work and revising it critically for important intellectual content: ETvdW/LJD/PvF/EWB. Final approval of the version to be published: ETvdW/LJD/PvF/EWB. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: ETvdW/LJD/PvF/EWB.

    • Funding This research was supported in part by an unrestricted grant of WALA Heilmittel GmbH, Germany.

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data are available through NHS digital.