Impact of the COVID-19 pandemic on antibiotic prescribing in high-prescribing primary care physicians in Switzerland

Soheila Aghlmandi; Florian S Halbeisen; Pascal Godet; Andri Signorell; Simon Sigrist; Ramon Saccilotto; Andreas F Widmer; Andreas Zeller; Julia Bielicki; Heiner C Bucher

doi:10.1016/j.cmi.2023.11.010

Impact of the COVID-19 pandemic on antibiotic prescribing in high-prescribing primary care physicians in Switzerland

Clin Microbiol Infect. 2024 Mar;30(3):353-359. doi: 10.1016/j.cmi.2023.11.010. Epub 2023 Nov 22.

Authors

Affiliations

¹ Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland; Paediatric Research Center, University Children's Hospital Basel (UKBB), Basel, Switzerland. Electronic address: soheila.aghlmandi@ukbb.ch.
² Surgical Outcome Research Center, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland.
³ Sanitas Health Insurance, Zurich, Switzerland.
⁴ Helsana Health Insurance, Zurich, Switzerland.
⁵ CSS Health Insurance, Lucerne, Switzerland.
⁶ Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland.
⁷ Division of Infectious Diseases and Hospital Hygiene, University Hospital Basel and University of Basel, Basel, Switzerland.
⁸ Centre for Primary Health Care, University of Basel, Basel, Switzerland.
⁹ Infectious Diseases and Paediatric Research Centre University of Basel Children's Hospital and University of Basel, Basel, Switzerland; Centre for Neonatal and Paediatric Infection, St. George's University, London, UK.
¹⁰ Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland.

PMID: 38000535
DOI: 10.1016/j.cmi.2023.11.010

Abstract

Objectives: The aim of this study was to evaluate antibiotic prescribing of medium-to-high prescribing primary care physicians being followed up after the completion of a Swiss national intervention trial of antibiotic prescription audit and feedback in the first SARS-CoV-2 pandemic year.

Methods: We used health insurer based claims data to calculate monthly antibiotic prescription rates per 100 consultations (primary endpoint) and applying interrupted time series (ITS) analysis methods, we estimated the immediate (step change) and sustained effects (slope) of the SARS-CoV-2 epidemic in 2020 on antibiotic prescribing compared to the pre-pandemic trial period from 2017-2019.

Results: We analysed data of 2945 of 3426 physicians (86.0%) from the trial with over 4 million consultations annually, who were in 2020 still in practice. Consultations dropped by 43% during the first pandemic year compared with 2017. Median monthly antibiotic prescription rates per 100 consultations in 2017 were 8.44 (Interquartile range [IQ] 6.32-11.50) and 8.35 (6.34-11.74) in the intervention and control groups, respectively, and increased to 15.63 (10.69-23.81) and 16.31 (10.65-24.72) per 100 consultations in 2020. ITS-derived incidence rate ratios for overall antibiotic prescriptions were 2.32 (95% CI 2.07-2.59) for the immediate pandemic effect, and 0.96 (0.95-0.98) for the sustained effect (change in slope in 2020 compared with 2017-2019).

Discussion: The SARS-CoV-2 pandemic had a major impact on antibiotic prescription patterns in primary care in Switzerland. For future viral pandemics, intervention plans with timely activation steps to minimize unjustified antibiotic consumption in primary care should be prepared.

Keywords: Antibiotics; COVID-19; Claims data; Prescriptions; Primary care.

MeSH terms

Anti-Bacterial Agents / therapeutic use
COVID-19* / epidemiology
Humans
Pandemics
Physicians, Primary Care*
Practice Patterns, Physicians'
Primary Health Care
SARS-CoV-2
Switzerland / epidemiology

Substances

Anti-Bacterial Agents