Judith Charlton’s research while affiliated with The London College and other places

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Publications (88)


FIGURE 1 Distribution of the proportion of the RTI consultations with antibiotics prescribed at 568 UK general practices. 6 Reproduced from Gulliford et al. 5 This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: https://creativecommons.org/licenses/by/4.0/. The figure includes minor additions and formatting changes to the original figure.
FIGURE 4 Flow chart showing the classification of antibiotic prescriptions from 2002 to 2017. Figures are frequencies (per cent of total number of antibiotic prescriptions).
FIGURE 13 Flow chart showing participant selection for the main and linked samples.
Trends in sepsis and localised infections in the UK 4
Groups of serious bacterial infections, including numbers of medical codes and the five most frequently recorded conditions

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Safety of reducing antibiotic prescribing in primary care: a mixed-methods study
  • Article
  • Full-text available

May 2021

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573 Reads

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10 Citations

Health Services and Delivery Research

Martin C Gulliford

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Judith Charlton

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Background The threat of antimicrobial resistance has led to intensified efforts to reduce antibiotic utilisation, but serious bacterial infections are increasing in frequency. Objectives To estimate the risks of serious bacterial infections in association with lower antibiotic prescribing and understand stakeholder views with respect to safe antibiotic reduction. Design Mixed-methods research was undertaken, including a qualitative interview study of patient and prescriber views that informed a cohort study and a decision-analytic model, using primary care electronic health records. These three work packages were used to design an application (app) for primary care prescribers. Data sources The Clinical Practice Research Datalink. Setting This took place in UK general practices. Participants A total of 706 general practices with 66.2 million person-years of follow-up from 2002 to 2017 and antibiotic utilisation evaluated for 671,830 registered patients. The qualitative study included 31 patients and 30 health-care professionals from primary care. Main outcome measures Sepsis and localised bacterial infections. Results Patients were concerned about antimicrobial resistance and the side effects, as well as the benefits, of antibiotic treatment. Prescribers viewed the onset of sepsis as the most concerning potential outcome of reduced antibiotic prescribing. More than 40% of antibiotic prescriptions in primary care had no coded indication recorded across both Vision ® and EMIS ® practice systems. Antibiotic prescribing rates varied widely between general practices, but there was no evidence that serious bacterial infections were less frequent at higher prescribing practices (adjusted rate ratio for 20% increase in prescribing 1.03, 95% confidence interval 1.00 to 1.06; p = 0.074). The probability of sepsis was lower if an antibiotic was prescribed at an infection consultation, and the number of antibiotic prescriptions required to prevent one episode of sepsis (i.e. the number needed to treat) decreased with age. For those aged 0–4 years, the number needed to treat was 29,773 (95% uncertainty interval 18,458 to 71,091) in boys and 27,014 (95% uncertainty interval 16,739 to 65,709) in girls. For those aged > 85 years, the number needed to treat was 262 (95% uncertainty interval 236 to 293) in men and 385 (95% uncertainty interval 352 to 421) in women. Frailty was associated with a greater risk of sepsis and a smaller number needed to treat. For severely frail patients aged 55–64 years, the number needed to treat was 247 (95% uncertainty interval 156 to 459) for men and 343 (95% uncertainty interval 234 to 556) for women. At all ages, the probability of sepsis was greatest for urinary tract infection, followed by skin infection and respiratory tract infection. The numbers needed to treat were generally smaller for the period 2014–17, when sepsis was diagnosed more frequently. The results are available using an app that we developed to provide primary care prescribers with stratified risk estimates during infection consultations. Limitations Analyses were based on non-randomised comparisons. Infection episodes and antibiotic prescribing are poorly documented in primary care. Conclusions Antibiotic treatment is generally associated with lower risks, but the most serious bacterial infections remain infrequent even without antibiotic treatment. This research identifies risk strata in which antibiotic prescribing can be more safely reduced. Future work The software developed from this research may be further developed and investigated for antimicrobial stewardship effect. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research ; Vol. 9, No. 9. See the NIHR Journals Library website for further project information.

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Peritonsillar Abscess and Antibiotic Prescribing for Respiratory Infection in Primary Care: A Population-Based Cohort Study and Decision-Analytic Model

September 2020

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11 Reads

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3 Citations

The Annals of Family Medicine

Purpose: To quantify the risk of peritonsillar abscess (PTA) following consultation for respiratory tract infection (RTI) in primary care. Method: A cohort study was conducted in the UK Clinical Practice Research Datalink including 718 general practices with 65,681,293 patient years of follow-up and 11,007 patients with a first episode of PTA. From a decision tree, Bayes theorem was employed to estimate both the probability of PTA following an RTI consultation if antibiotics were prescribed or not, and the number of patients needed to be treated with antibiotics to prevent 1 PTA. Results: There were 11,007 patients with PTA with age-standardized incidence of new episodes of PTA of 17.2 per 100,000 patient years for men and 16.1 for women; 6,996 (64%) consulted their practitioner in the 30 days preceding PTA diagnosis, including 4,243 (39%) consulting for RTI. The probability of PTA following an RTI consultation was greatest in men aged 15 to 24 years with 1 PTA in 565 (95% uncertainty interval 527 to 605) RTI consultations without antibiotics prescribed but 1 in 1,139 consultations (1,044 to 1,242) if antibiotics were prescribed. One PTA might be avoided for every 1,121 (975 to 1,310) additional antibiotic prescriptions for men aged 15 to 24 years and 926 (814 to 1,063) for men aged 25 to 34 years. The risk of PTA following RTI consultation was smaller and the number needed to treat higher at other ages and risks were lower in women than men. Conclusions: The risk of PTA may be lower if antibiotics are prescribed for RTI but even in young men nearly 1,000 antibiotic prescriptions may be required to prevent 1 PTA case. We caution that lack of randomization and data standardization may bias estimates.


Probability of sepsis after infection consultations in primary care in the United Kingdom in 2002–2017: Population-based cohort study and decision analytic model

July 2020

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76 Reads

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21 Citations

Background Efforts to reduce unnecessary antibiotic prescribing have coincided with increasing awareness of sepsis. We aimed to estimate the probability of sepsis following infection consultations in primary care when antibiotics were or were not prescribed. Methods and findings We conducted a cohort study including all registered patients at 706 general practices in the United Kingdom Clinical Practice Research Datalink, with 66.2 million person-years of follow-up from 2002 to 2017. There were 35,244 first episodes of sepsis (17,886, 51%, female; median age 71 years, interquartile range 57–82 years). Consultations for respiratory tract infection (RTI), skin or urinary tract infection (UTI), and antibiotic prescriptions were exposures. A Bayesian decision tree was used to estimate the probability (95% uncertainty intervals [UIs]) of sepsis following an infection consultation. Age, gender, and frailty were evaluated as association modifiers. The probability of sepsis was lower if an antibiotic was prescribed, but the number of antibiotic prescriptions required to prevent one episode of sepsis (number needed to treat [NNT]) decreased with age. At 0–4 years old, the NNT was 29,773 (95% UI 18,458–71,091) in boys and 27,014 (16,739–65,709) in girls; over 85 years old, NNT was 262 (236–293) in men and 385 (352–421) in women. Frailty was associated with greater risk of sepsis and lower NNT. For severely frail patients aged 55–64 years, the NNT was 247 (156–459) in men and 343 (234–556) in women. At all ages, the probability of sepsis was greatest for UTI, followed by skin infection, followed by RTI. At 65–74 years, the NNT following RTI was 1,257 (1,112–1,434) in men and 2,278 (1,966–2,686) in women; the NNT following skin infection was 503 (398–646) in men and 784 (602–1,051) in women; following UTI, the NNT was 121 (102–145) in men and 284 (241–342) in women. NNT values were generally smaller for the period from 2014 to 2017, when sepsis was diagnosed more frequently. Lack of random allocation to antibiotic therapy might have biased estimates; patients may sometimes experience sepsis or receive antibiotic prescriptions without these being recorded in primary care; recording of sepsis has increased over the study period. Conclusions These stratified estimates of risk help to identify groups in which antibiotic prescribing may be more safely reduced. Risks of sepsis and benefits of antibiotics are more substantial among older adults, persons with more advanced frailty, or following UTIs.


Figure 1 Age-standardised and sex-standardised antibiotic prescribing rates per 1000 patient-years for coded and not coded indications from 2002 to 2017. AB, antibiotic; GUTI, genito-urinary tract infection; RTI, respiratory tract infection.
Variation in antibiotic prescribing between family practices
Serious bacterial infections and antibiotic prescribing in primary care: Cohort study using electronic health records in the UK

February 2020

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73 Reads

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21 Citations

BMJ Open

Objective This study evaluated whether serious bacterial infections are more frequent at family practices with lower antibiotic prescribing rates. Design Cohort study. Setting 706 UK family practices in the Clinical Practice Research Datalink from 2002 to 2017. Participants 10.1 million registered patients with 69.3 million patient-years’ follow-up. Exposures All antibiotic prescriptions, subgroups of acute and repeat antibiotic prescriptions, and proportion of antibiotic prescriptions associated with specific-coded indications. Main outcome measures First episodes of serious bacterial infections. Poisson models were fitted adjusting for age group, gender, comorbidity, deprivation, region and calendar year, with random intercepts representing family practice-specific estimates. Results The age-standardised antibiotic prescribing rate per 1000 patient-years increased from 2002 (male 423; female 621) to 2012 (male 530; female 842) before declining to 2017 (male 449; female 753). The median family practice had an antibiotic prescribing rate of 648 per 1000 patient-years with 95% range for different practices of 430–1038 antibiotic prescriptions per 1000 patient-years. Specific coded indications were recorded for 58% of antibiotic prescriptions at the median family practice, the 95% range at different family practices was from 10% to 75%. There were 139 759 first episodes of serious bacterial infection. After adjusting for covariates and the proportion of coded consultations, there was no evidence that serious bacterial infections were lower at family practices with higher total antibiotic prescribing. The adjusted rate ratio for 20% higher total antibiotic prescribing was 1.03, (95% CI 1.00 to 1.06, p=0.074). Conclusions We did not find population-level evidence that family practices with lower total antibiotic prescribing might have more frequent occurrence of serious bacterial infections overall. Improving the recording of infection episodes has potential to inform better antimicrobial stewardship in primary care.


Importance of Frailty for Association of Antipsychotic Drug Use With Risk of Fracture: Cohort Study Using Electronic Health Records

July 2019

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19 Reads

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10 Citations

Journal of the American Medical Directors Association

Objective: To evaluate association of first- or second-generation antipsychotic (AP) drugs with fracture risk at different levels of frailty over the age of 80 years. Design: Population-based cohort study. Setting and participants: United Kingdom Clinical Practice Research Datalink including 153,304 patients aged 80 years and older between 2006 and 2015. Methods: Rates of fracture and adjusted rate ratios (RR) were estimated by AP drug exposure category, adjusting for age, sex, frailty, number of deficits, and dementia diagnosis. Results: Data were analyzed for 165,726 treatment episodes (153,304 patients; 61.3% women; mean age 83 years; 21,365 fractures; 681,221.1 person-years of follow-up). AP exposure was associated with increasing age, frailty, and dementia diagnosis. After adjusting for frailty and covariates, first-generation AP exposure was associated with risk of any fracture, RR 1.24 (95% confidence interval 1.07-1.43, P = .003). Second-generation AP exposure was associated with femur fracture (RR 1.41, 1.22-1.64, P < .001) but less strongly with any fracture (RR 1.12, 1.01-1.24, P = .033). Fracture incidence increased with frailty level. The number of person-years of first-generation AP treatment associated with 1 additional fracture at any site was 75 (42-257) for severely frail patients but 187 (95% confidence interval 104-640) for 'fit' patients. For second-generation AP, 1 additional femur fracture might result from 173 (111-323) person-years treatment in severe frailty but 365 (234-681) person-years treatment for 'fit' patients. Conclusions and implications: Frail patients are more likely to receive AP drug treatment, but their absolute risk of AP-associated fracture is substantially greater than for nonfrail patients.


Electronically delivered interventions to reduce antibiotic prescribing for respiratory infections in primary care: cluster RCT using electronic health records and cohort study

March 2019

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128 Reads

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32 Citations

Health technology assessment (Winchester, England)

Background Unnecessary prescribing of antibiotics in primary care is contributing to the emergence of antimicrobial drug resistance. Objectives To develop and evaluate a multicomponent intervention for antimicrobial stewardship in primary care, and to evaluate the safety of reducing antibiotic prescribing for self-limiting respiratory infections (RTIs). Interventions A multicomponent intervention, developed as part of this study, including a webinar, monthly reports of general practice-specific data for antibiotic prescribing and decision support tools to inform appropriate antibiotic prescribing. Design A parallel-group, cluster randomised controlled trial. Setting The trial was conducted in 79 general practices in the UK Clinical Practice Research Datalink (CPRD). Participants All registered patients were included. Main outcome measures The primary outcome was the rate of antibiotic prescriptions for self-limiting RTIs over the 12-month intervention period. Cohort study A separate population-based cohort study was conducted in 610 CPRD general practices that were not exposed to the trial interventions. Data were analysed to evaluate safety outcomes for registered patients with 45.5 million person-years of follow-up from 2005 to 2014. Results There were 41 intervention trial arm practices (323,155 patient-years) and 38 control trial arm practices (259,520 patient-years). There were 98.7 antibiotic prescriptions for RTIs per 1000 patient-years in the intervention trial arm (31,907 antibiotic prescriptions) and 107.6 per 1000 patient-years in the control arm (27,923 antibiotic prescriptions) [adjusted antibiotic-prescribing rate ratio (RR) 0.88, 95% confidence interval (CI) 0.78 to 0.99; p = 0.040]. There was no evidence of effect in children aged < 15 years (RR 0.96, 95% CI 0.82 to 1.12) or adults aged ≥ 85 years (RR 0.97, 95% CI 0.79 to 1.18). Antibiotic prescribing was reduced in adults aged between 15 and 84 years (RR 0.84, 95% CI 0.75 to 0.95), that is, one antibiotic prescription was avoided for every 62 patients (95% CI 40 to 200 patients) aged 15–84 years per year. Analysis of trial data for 12 safety outcomes, including pneumonia and peritonsillar abscess, showed no evidence that these outcomes might be increased as a result of the intervention. The analysis of data from non-trial practices showed that if a general practice with an average list size of 7000 patients reduces the proportion of RTI consultations with antibiotics prescribed by 10%, then 1.1 (95% CI 0.6 to 1.5) more cases of pneumonia per year and 0.9 (95% CI 0.5 to 1.3) more cases of peritonsillar abscesses per decade may be observed. There was no evidence that mastoiditis, empyema, meningitis, intracranial abscess or Lemierre syndrome were more frequent at low-prescribing practices. Limitations The research was based on electronic health records that may not always provide complete data. The number of practices included in the trial was smaller than initially intended. Conclusions This study found evidence that, overall, general practice antibiotic prescribing for RTIs was reduced by this electronically delivered intervention. Antibiotic prescribing rates were reduced for adults aged 15–84 years, but not for children or the senior elderly. Future work Strategies for antimicrobial stewardship should employ stratified interventions that are tailored to specific age groups. Further research into the safety of reduced antibiotic prescribing is also needed. Trial registration Current Controlled Trials ISRCTN95232781. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol. 23, No. 11. See the NIHR Journals Library website for further project information.



Table 3 | Association of antibiotic prescribing rate for self limiting respiratory tract infection with use of decision support tools, by age group
Effectiveness and safety of electronically-delivered prescribing feedback and decision support on antibiotic utilisation for respiratory illness in primary care. REDUCE cluster-randomised trial

December 2018

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138 Reads

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115 Citations

The BMJ

Objectives: To evaluate the effectiveness and safety at population-scale of electronically delivered prescribing feedback and decision support interventions at reducing antibiotic (AB) prescribing for self-limiting respiratory infections (RTI). Design: Open-label, two-arm, cluster randomised controlled trial Setting: UK general practices in the Clinical Practice Research Datalink Participants: 79 general practices (582,675 patient-years) randomised (1:1) to antimicrobial stewardship (AMS) intervention or usual care. Interventions: The AMS intervention comprised a brief training webinar, automated monthly feedback reports of AB prescribing, and electronic decision support tools to inform appropriate AB prescribing over 12 months. Intervention components were delivered electronically, supported by a local practice ‘champion’. Main outcome measures: The primary outcome was the rate of AB prescriptions for RTI from electronic health records. Serious bacterial complications were evaluated for safety. Analysis was by Poisson regression with general practice as a random effect, adjusting for covariates. Pre-specified sub-group analyses by age-group are reported. Results: There were 41 AMS trial arm practices (323,155 patient-years) and 38 usual care trial arm practices (259,520 patient-years). AB prescribing rate ratios (RR) were: unadjusted, 0.89 (0.86 to 1.16); and adjusted, 0.88 (95% CI, 0.78 to 0.99, P=0.04); with AB prescribing rates of 98.7 per 1,000 patient-years for AMS (31,907 AB prescriptions) and 107.6 per 1,000 for usual care (27,923 AB prescriptions). AB prescribing was reduced most in adults aged 15-84 years (adjusted RR 0.84, 95%CI 0.75 to 0.95), with one antibiotic prescription per year avoided for every 62 (40 to 200) patients. There was no evidence of effect for children less than 15 years (adjusted RR 0.96, 0.82 to 1.12) or adults aged 85 years and older (adjusted RR 0.97, 0.79 to 1.18). There was no evidence that serious bacterial complications increased (adjusted RR 0.92, 0.74 to 1.13). Conclusions: Electronically-delivered interventions, integrated into practice workflow result in moderate reductions AB prescribing for RTI in adults, which are likely to be of importance for public health. Antibiotic prescribing to children or older people requires further evaluation. Trial registration: ISRCTN95232781<br/


Long-term trends in antithrombotic drug prescriptions among adults age 80 years and over from primary care. A temporal trends analysis using electronic health records

March 2018

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21 Reads

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21 Citations

Annals of Epidemiology

Purpose This study aimed to estimate trends in antithrombotic prescriptions from 2001 to 2015 among people aged 80 years and over within clinical indications. Methods A prospective cohort study with 215,559 participants registered with the UK Clinical Practice Research Datalink from 2001 to 2015 was included in the analyses. The prevalence and incidence of antiplatelet and anticoagulant drugs were estimated for each year and by five clinical indications. Results The prevalence rate of antithrombotic prescriptions among patients aged over 80 years and diagnosed with atrial fibrillation increased from 53% in 2001 to 77% in 2015 (Ptrend <.001). Anticoagulant prescriptions rates also increased five-fold in older adults with atrial fibrillation from around 10% in 2001 to 46% in 2015 (Ptrend <.001). Clopidogrel-prescribing rates in patients aged over 80 years and with venous thrombosis increased from 0.4% in 2001 to 10% in 2015 (Ptrend <.001). Warfarin-prescribing rates in older patients with venous thrombosis increased from 13% in 2001 to 21% in 2015 (Ptrend <.001). Conclusions The use of antithrombotic drugs increased from 2001 to 2015 in people aged 80 years and over across multiple clinical indications. Assessing the benefits and harms of antithrombotic drugs across different clinical indications in older people is a priority.


Incidence and mortality of fractures by frailty level over 80 years of age: cohort study using UK electronic health records

January 2018

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244 Reads

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61 Citations

BMJ Open

Objective This study aimed to estimate the association of frailty with incidence and mortality of fractures at different sites in people aged over 80 years. Design Cohort study. Setting UK family practices from 2001 to 2014. Participants 265 195 registered participants aged 80 years and older. Measurements Frailty status classified into ‘fit’, ‘mild’, ‘moderate’ and ‘severe’ frailty. Fractures, classified into non-fragility and fragility, including fractures of femur, pelvis, shoulder and upper arm, and forearm/wrist. Incidence of fracture, and mortality within 90 days and 1 year, were estimated. Results There were 28 643 fractures including: non-fragility fractures, 9101; femur, 12 501; pelvis, 2172; shoulder and upper arm, 4965; and forearm/wrist, 6315. The incidence of each fracture type was higher in women and increased with frailty category (femur, severe frailty compared with ‘fit’, incidence rate ratio (IRR) 2.4, 95% CI 2.3 to 2.6). Fractures of the femur (95–99 years compared with 80–84 years, IRR 2.7, 95% CI 2.6 to 2.9) and pelvis (IRR 2.9, 95% CI 2.5 to 3.3) were strongly associated with age but non-fragility and forearm fractures were not. Mortality within 90 days was greatest for femur fracture (adjusted HR, compared with forearm fracture 4.3, 95% CI 3.7 to 5.1). Mortality was higher in men and increased with age (HR 5.3, 95% CI 4.3 to 6.5 in those over 100 years compared with 80–84 years) but was less strongly associated with frailty category. Similar associations with fractures were seen at 1-year mortality. Conclusions The incidence of fractures at all sites was higher in women and strongly associated with advancing frailty status, while the risk of mortality after a fracture was greater in men and was associated with age rather than frailty category.


Citations (63)


... In uncertain diagnoses, some physicians may over-prescribe antibiotics as a precaution (Thakolkaran et al. 2017). Patient pressure, particularly the misconception that antibiotics are needed for viral infections, exacerbates this issue (Macfarlane et al. 1997;Butler et al. 1998;Faber et al. 2010;Thakolkaran et al. 2017;Gulliford et al. 2021), leading to unnecessary antibiotic prescriptions to meet expectations and maintain satisfaction (Shapiro 2002). ...

Reference:

Impact of demographic and professional factors on antibiotic prescription patterns in the post-COVID-19 era
Safety of reducing antibiotic prescribing in primary care: a mixed-methods study

Health Services and Delivery Research

... In this study, all our patients were adults, and the average age was 33 years, but considering the standard deviation, the range was approximately 23 to 43 years, which aligns with previous reports, suggesting similar demographic distributions to other populations. PTA was found to be more common among the females in this study, which contrasts with previous reports (2,8). This finding may be due to our small sample size, and it may not be the true representation of patients with PTA in our population. ...

Peritonsillar Abscess and Antibiotic Prescribing for Respiratory Infection in Primary Care: A Population-Based Cohort Study and Decision-Analytic Model
  • Citing Article
  • September 2020

The Annals of Family Medicine

... Early control of infection and prompt antibiotic administration are crucial for the outcome of some serious infections, such as pneumonia or septic shock, which occur in very few cases, but the risk of which particularly increases in older and frail individuals. 16 However, a recent paper highlighted the lack of relationship between a patient's level of risk and their likelihood of being prescribed an antibiotic in primary care. 17 Panel 1: Risks that have shown to be associated with unnecessary antibiotic use. ...

Probability of sepsis after infection consultations in primary care in the United Kingdom in 2002–2017: Population-based cohort study and decision analytic model

... Twenty-nine unique data sources were identified in these studies; five studies were conducted with data from the Clinical Practice Research Datalink (CPRD) [19][20][21][22][23] and two obtained data from the same two private family medicine clinics 24,25 EMR data for supporting AMS Six categories of EMR data used for supporting AMS were identified from the studies included in the review. These were, (i) assessing antimicrobial prescribing quality, 23,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] (ii) measuring the effectiveness of an intervention, 25,28,29,34,37,38,[40][41][42][43][44] (iii) analyzing antimicrobial prescribing trends, [22][23][24]26,27,31,36,37,39,[45][46][47][48][49][50][51][52] , (iv) assessing patient and provider characteristics in prescribing [21][22][23][24]26,27,31,32,36,38,39,47,49,51,52 (v) evaluating novel tools or measures 33,53 , and (vi) measuring specific conditions and outcomes. 19,23,35,48,50,52 The specific conditions and outcomes measured were: serious infection rates due to lower antibiotic prescribing, impetigo incidence, treatment and recurrence, prevalence and documentation quality of beta-lactam allergies, changes in antibiotic prescribing for different patient demographics and indications over time, male urinary tract infection prevalence, and pre-and post-pandemic respiratory tract infection (RTI) presentations. ...

Serious bacterial infections and antibiotic prescribing in primary care: Cohort study using electronic health records in the UK

BMJ Open

... [14][15][16][17] Prior research exploring the nexus between pharmacotherapy and frailty in the geriatric population has largely concentrated on medication such as antihypertensive agents, antidiabetic drugs and antipsychotic drugs. [18][19][20] However, there is a noticeable absence of scholarly discussion regarding the potential adverse effects of PPI and their connection with frailty in older adults. Several factors may contribute to this oversight. ...

Importance of Frailty for Association of Antipsychotic Drug Use With Risk of Fracture: Cohort Study Using Electronic Health Records
  • Citing Article
  • July 2019

Journal of the American Medical Directors Association

... Studies have shown that antibiotics are often applied unnecessarily, especially for community-acquired acute respiratory tract infections (CA-ARTIs) in outpatient care [11][12][13]. CA-ARTIs affect primarily the lower or upper respiratory tract. Typical lower respiratory tract infections are bronchitis and pneumonia. ...

Electronically delivered interventions to reduce antibiotic prescribing for respiratory infections in primary care: cluster RCT using electronic health records and cohort study
  • Citing Article
  • March 2019

Health technology assessment (Winchester, England)

... Numerous approaches to reduce antibiotic misuse are more successful and impactful, better than single initiatives [6,9,21]. Interventions should include implementing Antimicrobial Stewardship (AMS) programs, following evidence-based procedures and standards, improving communication skills with pediatric patients and parents, and providing training resources [22,23]. A study suggests providing frequent, up-to-date training sessions for mothers to enhance their knowledge awareness, opinions, and practice while using antibiotics for their children [24]. ...

Effectiveness and safety of electronically-delivered prescribing feedback and decision support on antibiotic utilisation for respiratory illness in primary care. REDUCE cluster-randomised trial

The BMJ

... In recent years, the incidence of CHD and CVD has been increasing in the elderly population, and the use of anti-thrombotic drugs has been increasing accordingly [18]. CSH is one of the complications of anti-thrombotic drugs, and several studies have reported a correlation between the use of anti-thrombotic drugs and the incidence of CSH [4,18]. ...

Long-term trends in antithrombotic drug prescriptions among adults age 80 years and over from primary care. A temporal trends analysis using electronic health records
  • Citing Article
  • March 2018

Annals of Epidemiology

... 16 However, our study shows that this protective affect may occur at an even earlier time frame. Additionally, the results of this study showed that ambulation during hospital admission resulted in a 17-fold reduction in mortality rates at 90 days, 17,18 which is a stronger protective factor than what has been previously reported in the literature when examining longer time frames. 16 Previous epidemiological studies have shown similar relationships between discharge status and 90-day mortality rates with those patients discharged to inpatient rehabilitation facility or skilled nursing facilities demonstrating a statistically significant increase in mortality at both 90 and 180 days postop. ...

Incidence and mortality of fractures by frailty level over 80 years of age: cohort study using UK electronic health records

BMJ Open

... The most frequently deprescribed medications include benzodiazepines, which are depressant drugs used to produce sedation and hypnosis to relieve anxiety [46,47]; proton-pump inhibitors, a class of drugs commonly used to manage acid-related conditions [48,49]; statins, which are medications that reduce cholesterol levels [50,51]; opioid analgesics, which are a class of medications that are used for pain relief and act on opioid receptors to produce morphine-like effects [52]; and antipsychotics [53]. Despite the possible benefits of deprescribing, several barriers exist, such as the patient's fear of symptom recurrence [14], the patient's concern about withdrawal symptoms [54], and insufficient time during medical appointments can pose challenges when it comes to engaging in conversations about the deprescription process with both patients and their families [55]. ...

Inception and deprescribing of statins in people aged over 80 years: Cohort study
  • Citing Article
  • November 2017

Age and Ageing