The impact of a national antimicrobial stewardship program on antibiotic prescribing in primary care: An interrupted time series analysis

Violeta Balinskaite*, Alan Johnson, Alison Holmes, Paul Aylin

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

29 Citations (Scopus)


Background. The Quality Premium was introduced in 2015 to financially reward local commissioners of healthcare in England for targeted reductions in antibiotic prescribing in primary care. Methods. We used a national antibiotic prescribing dataset from April 2013 until February 2017 to examine the number of antibiotic items prescribed, the total number of antibiotic items prescribed per STAR-PU (specific therapeutic group age/sex-related prescribing units), the number of broad-spectrum antibiotic items prescribed, and broad-spectrum antibiotic items prescribed, expressed as a percentage of the total number of antibiotic items. To evaluate the impact of the Quality Premium on antibiotic prescribing, we used a segmented regression analysis of interrupted time series data. Results. During the study period, over 140 million antibiotic items were prescribed in primary care. Following the introduction of the Quality Premium, antibiotic items prescribed decreased by 8.2%, representing 5 933 563 fewer antibiotic items prescribed during the 23 post-intervention months, as compared with the expected numbers based on the trend in the pre-intervention period. After adjusting for the age and sex distribution in the population, the segmented regression model also showed a significant relative decrease in antibiotic items prescribed per STAR-PU. A similar effect was found for broad-spectrum antibiotics (comprising 10.1% of total antibiotic prescribing), with an 18.9% reduction in prescribing. Conclusions. This study shows that the introduction of financial incentives for local commissioners of healthcare to improve the quality of prescribing was associated with a significant reduction in both total and broad-spectrum antibiotic prescribing in primary care in England.

Original languageEnglish
Pages (from-to)227-232
Number of pages6
JournalClinical Infectious Diseases
Issue number2
Publication statusPublished - 2 Jul 2019

Bibliographical note

Funding Information:
Financial support. This work was supported by the NIHR Policy Research Programme (research to determine the impact of the national antimicrobial stewardship programs on clinical outcomes and patient safety and to establish sustainable systems). The Dr Foster Unit—an academic unit in the Department of Primary Care and Public Health, within the School of Public Health, Imperial College London—receives research funding from the NIHR and Dr Foster Intelligence, an independent health service research organization (a wholly-owned subsidiary of Telstra). This work was supported by the NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London in partnership with Public Health England. The Department of Primary Care & Public Health at Imperial College London is supported by the North West London NIHR Collaboration for Leadership in Applied Health Research & Care and the Imperial NIHR Biomedical Research Centre.


  • Antibiotic prescribing
  • Antimicrobial stewardship programs
  • Interrupted time series


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