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Influenza-like illness and antimicrobial prescribing in Australian general practice from 2015 to 2017: a national longitudinal study using the MedicineInsight dataset
  1. Carla De Oliveira Bernardo1,
  2. David Gonzalez-Chica1,2,
  3. Nigel Stocks1,3
  1. 1 Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
  2. 2 Adelaide Rural Clinical School, University of Adelaide, Adelaide, South Australia, Australia
  3. 3 Australian Partnership for Preparedness Research on InfectiouS disease Emergencies (APPRISE), Adelaide, South Australia, Australia
  1. Correspondence to Dr Carla De Oliveira Bernardo; carla.bernardo{at}adelaide.edu.au

Abstract

Objectives To investigate the epidemiology of influenza-like illness (ILI) by general practice and patient characteristics, and explore whether sociodemographic variables or comorbidities affect antiviral or antibiotic prescribing.

Design Open cohort study.

Setting A representative sample of 550 Australian general practices contributing data to the MedicineInsight programme.

Participants 4 228 149 patients of all age groups who had at least one consultation between 2015 and 2017. Median age was 37 years (Interquartile range: 21–57), 54.4% women, 16.4% aged ≥65 years, 2.2% Aboriginal or Torres Strait Islander, 17.6% had a chronic disease and 18.1% a mental health condition.

Primary and secondary outcome measures ILI consultation rates (per 1000 consultations) were calculated using all ILI diagnoses for all clinical encounters with a general practitioner between 2015 and 2017. Antiviral and antibiotic prescribing for ILI cases were investigated and logistic regression models adjusted for practice and patient characteristics used to analyse associations.

Results ILI consultation rates in 2017 were higher than in previous years. Antiviral prescribing increased from 20.6% in 2015, to 23.7 in 2016 and 29.7% in 2017, while antibiotic prescribing decreased from 30.3% to 28.0% and 26.7%, respectively (p<0.05 in both cases). Practices located in high socioeconomic areas had higher ILI consultation rates (4.3 vs 2.5 per 1000 consultations, p<0.05), antibiotic (30.7% vs 23.4%, p<0.05) and antiviral (34.2% vs 13.5%, p<0.05) prescribing than those in lower socioeconomic areas. The coexistence of chronic or mental health conditions was associated with lower ILI consultation rates, higher antibiotic use, but not with antiviral prescribing. However, those with chronic respiratory conditions had a higher frequency of antibiotic and antiviral prescribing in 2017 than individuals with other comorbidities.

Conclusions Although the apparent decline in antibiotic prescribing for ILI is welcome, the increase in antiviral use may not be targeting those at high risk of complications from infection.

  • influenza-like illness
  • general practice
  • medical records
  • antibiotic prescribing
  • antiviral prescribing

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, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors All authors made significant contributions to the manuscript and are responsible for its content. NS conceived the idea and planned this study. CDOB and DG-C were responsible for data extraction and analysis, interpreting and presenting the results. CDOB wrote the first draft and the revisions. DG-C contributed to the manuscript refinement. NS contributed to revisions and the final version of the manuscript. All authors have read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval The Human Research Ethics Committee of the University of Adelaide exempted this study of an ethical review, considering it used existing and non-identifiable data.

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

  • Data sharing statement No additional data are available, as the original dataset belongs to a third party.

  • Patient consent for publication Not required.

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