The influence of non-medical prescribers on antimicrobial stewardship: a national evaluation of the impact of the COVID-19 pandemic on the prescribing of antibiotics by non-medical prescribers in England in 2020 (part 2)
Part one of this study identified that prescribing behaviours during 2020 differed significantly from 2016-2021. Part 2, presented here, covers a more detailed analysis of the impact of the early part of the COVID-19 pandemic is presented here.
To describe patterns in community prescribed and dispensed antibiotic volumes attributable to non-medical prescribers during 2020 compared to the previous 4 years and identify any changes of behaviour during this period and their impact on antimicrobial stewardship.
An analysis of retrospective non-medical prescribers' prescribing data was performed to determine the numbers of independent non-medical prescribers and the patterns of prescribed community dispensed antibiotic volumes between 2016-2021. The 2020 data were then compared to the data from previous years.
The total amount of dispensed non-medical prescribers antibiotic prescription items per 100000 population dropped by 12% in 2020 compared to 2019, driven predominantly by reductions in nurse prescribing. However, high-risk antibiotic prescribing rose from 5.3% of antibiotics prescribed in 2019 to 6.4% in 2020. Seasonal patterns of antibiotic prescribing differed in 2020, with significant reductions in prescribing of antibiotics normally associated with treating LRTI from the first lockdown in March 2020.
The COVID-19 pandemic forced rapid changes in practice, including increased remote working, which created a challenging prescribing environment that adversely affected the high-risk antibiotic prescribing behaviour of non-medical prescribers more than it affected their medical colleagues. There were unusually low levels of prescribing for respiratory tract infections over the last quarter of 2020 which, although likely multifactorial, may indicate over-prescribing for self-limiting viral infections in previous years. More research is needed to establish ongoing prescribing trends and patient outcomes, and how antimicrobial stewardship programmes and training can be better targeted to support prescribers to address quality and safety issues arising from changing modes of practice.
In 2020, the COVID-19 pandemic dramatically reshaped primary care service delivery through increased remote consultation to reduce viral transmission. A systematic review of the evidence of its impact on antibiotic prescribing behaviour by Han et al (2020) was inconclusive. The studies included in Han et al's (2020) were conducted prior to the pandemic and the risk/benefit analysis of face-to-face consultations and the willingness and ability of both patients and clinicians to engage in them were very different, which may have influenced prescribing decisions.
Demonstrating the differences in prescribing patterns in 2020, compared to the preceding 4 years, will help understand whether non-medical prescribers (NMPs) were affected differently, compared to their medical colleagues in terms of their antibiotic prescribing when the majority of primary care consulting was moved to remote patient interactions. For the present study, changes in prescribing patterns as a result of the COVID-19 pandemic were analysed to identify any shifts in behaviour and how this may have affected the antimicrobial stewardship (AMS) of NMPs.
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