Consultations for XXXX , antibiotic prescribing and risk factors for reattendance: a case-linked cohort study.

@entity1 @entity2266 @entity2172 @entity697 @entity2169 @entity2346
BACKGROUND: @entity2346 media is the most common reason for @entity1 to receive antibiotics, but there is no evidence about the effect of prescribing on reattendance. AIM: To evaluate the changing workload of @entity2172 in general practice, and the impact on surgery reattendance of prescribing antibiotics at first attendance. DESIGN OF STUDY: A case-linked cohort analysis for antibiotic prescribing versus no prescribing at first consultation event. SETTING: Two hundred and ninety-one practices spread throughout the UK recording for the General Practice Research Database (GPRD) and incorporating individual @entity1 data records for 2,265,574 @entity1 . METHOD: All @entity2172 coded events that can be classed within @entity697 ( @entity697 ) or @entity2169 sub-categories (and excluding @entity2266 ) were selected for analysis when the first event was from 1991-2001. The effect of antibiotic prescription on the risk of reattendance using Cox proportional hazards regression was analysed. RESULTS: Total consultations for @entity697 have fallen markedly over this decade, and @entity2169 have risen but by a much smaller extent (26,000 decrease versus 4000 increase in consultations per year), which makes relabelling an unlikely explanation of the fall in @entity697 consultations. In the 2-10 years age range, consultations for @entity697 fell from 105.3 to 34.7 per 1000 per year, with @entity2169 unaltered (15.2 to 16.7 per 1000 per year). Antibiotic prescribing for @entity697 has stayed remarkably constant (80-84% of consultations), but antibiotic prescribing for @entity2169 has risen sharply (13 to 62%). Prescribing antibiotics increased the risk of reattendance for @entity697 (hazard ratio [HR] = 1.09, 95% confidence interval [CI] = 1.07 to 1.10) and has reduced the risk of reattendance for @entity2169 (HR = 0.92, 95% CI = 0.88 to 0.96). CONCLUSION: Prescribing antibiotics for @entity697 probably increased reattendance, but the opposite effect has been noted for @entity2169 , which suggests a treatment effect of antibiotics in @entity2169 . Further research is needed to clarify whether this possible benefit is worth the known harms, and if so in which subgroups of @entity1 .
