Primary day care antibiotics prescribing and out-of-hours care consumption.

Background & Aim: Restrictive antibiotics prescribing in primary care during office hours may lead to increased workload after hours. Therefore, we studied the extent to which patients with an upper respiratory tract infection (URTI) who consulted their GP and did not get an antibiotics prescription contacted the out-of-hours services afterwards, within the same disease episode. In addition, we studied whether restrictive prescribing during office hours can explain the GP practice variation in out-of-hours consultations for URTI. Method: Patient level data from electronic health records from general practitioners were linked to data from electronic health records of the primary out-of-hours services (OOH) participating in the NIVEL Primary Care Database. This yielded linked data on 417,041 patients from 102 GP practices and 18 out-of-hours services in the Netherlands of whom 38,579 patients (12,266 0-12 year olds and 26,313 aged 13 years or older) had at least one episode of URTI in 2013. Results: Preliminary analyses showed that 3.4% of the 0-12 year olds who consulted their GP during office hours also contacted an OOH within the same disease episode. Whether or not the GP prescribed antibiotics did not make a difference (4.3% vs 3.1%). Almost 1% of URTI patients ¬>13 contacted the OOH after consulting a GP during day care. Again, there was no difference between patients with and without antibiotics prescriptions during office hours (0.9% vs 0.8%). In addition, lower antibiotics prescribing rates of GPs in daycare were not associated with number of OOH contacts for URTI. Conclusions: Our results suggest that restrictive antibiotics prescribing during office hours does not invoke additional consultations after hours. However, the number of out-of-hours consultations for URTI related complaints varied greatly between day care GP practices, suggesting that other factors than antibiotics prescribing may be involved