Intended for healthcare professionals


Coding infections in primary care

BMJ 2019; 367 doi: (Published 11 December 2019) Cite this as: BMJ 2019;367:l6816

Linked Research

Antibiotic prescribing without documented indication in ambulatory care clinics

  1. Alastair D Hay, professor of primary care
  1. Centre for Academic Primary Care, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol BS8 2PS, UK
  1. alastair.hay{at}

A comprehensive coding system is central to effective antimicrobial stewardship

Antibiotics are one of the most commonly prescribed medicines in primary care worldwide, but as many as 23% in the United Kingdom1 and 25% in the United States2 are prescribed inappropriately. Governments concerned about the threat of antibiotic resistance have repeatedly called for improved stewardship to preserve antibiotic effectiveness for future generations.345

Reducing inappropriate prescribing requires behaviour change by clinicians. Providing peer-referenced prescribing data to individual clinicians is a proven method supporting behaviour change6 because it provides a strong counter to those who justify their prescribing by stating they deal with a different group of patients—for example, older patients with more long term chronic conditions, or more patients with acute problems. A peer-referenced individualised prescribing feedback system would work optimally if it met the following three criteria.

The first is that a diagnostic code is recorded every time an antibiotic is prescribed. Surprisingly, a substantial proportion of antibiotics prescribed in …

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