Association of strong opioids and antibiotics prescribing with GP burnout: a retrospective cross-sectional study

Hodkinson, Alexander; Zghebi, Salwa S; Kontopantelis, Evangelos; Grigoroglou, Christos; Ashcroft, Darren M; Hann, Mark; Chew-Graham, Carolyn A; Payne, Rupert A; Little, Paul; de Lusignan, Simon; Zhou, Anli; Esmail, Aneez; Panagioti, Maria

Abstract

Background: Prescribing of strong opioids and antibiotics impacts patient safety, yet little is known about the effects GP wellness has on overprescribing of both medications in primary care.

Aim: To examine associations between strong opioid and antibiotic prescribing and practice- weighted GP burnout and wellness.

Design and setting: A retrospective cross-sectional study was undertaken using prescription data on strong opioids and antibiotics from the Oxford- Royal College of General Practitioners Research and Surveillance Centre linking to a GP wellbeing survey overlaying the same 4-month period from December 2019 to April 2020.

Method: Patients prescribed strong opioids and antibiotics were the outcomes of interest.

Results: Data for 40 227 patients (13 483 strong opioids and 26 744 antibiotics) were linked to 57 practices and 351 GPs. Greater strong opioid prescribing was associated with increased emotional exhaustion (incidence risk ratio [IRR] 1.19, 95% confidence interval [CI] = 1.10 to 1.24), depersonalisation (IRR 1.10, 95% CI = 1.01 to 1.16), job dissatisfaction (IRR 1.25, 95% CI = 1.19 to 1.32), diagnostic uncertainty (IRR 1.12, 95% CI = 1.08 to 1.19), and turnover intention (IRR 1.32, 95% CI = 1.27 to 1.37) in GPs. Greater antibiotic prescribing was associated with increased emotional exhaustion (IRR 1.19, 95% CI = 1.05 to 1.37), depersonalisation (IRR 1.24, 95% CI = 1.08 to 1.49), job dissatisfaction (IRR 1.11, 95% CI = 1.04 to 1.19), sickness–presenteeism (IRR 1.18, 95% CI = 1.11 to 1.25), and turnover intention (IRR 1.38, 95% CI = 1.31 to 1.45) in GPs. Increased strong opioid and antibiotic prescribing was also found in GPs working longer hours (IRR 3.95, 95% CI = 3.39 to 4.61; IRR 5.02, 95% CI = 4.07 to 6.19, respectively) and in practices in the north of England (1.96, 95% CI = 1.61 to 2.33; 1.56, 95% CI = 1.12 to 3.70, respectively).

Conclusion: This study found higher rates of prescribing of strong opioids and antibiotics in practices with GPs with more burnout symptoms, greater job dissatisfaction, and turnover intentions; working longer hours; and in practices in the north of England serving more deprived populations.

Citation

Hodkinson, A., Zghebi, S. S., Kontopantelis, E., Grigoroglou, C., Ashcroft, D. M., Hann, M., …Panagioti, M. (in press). Association of strong opioids and antibiotics prescribing with GP burnout: a retrospective cross-sectional study. British Journal of General Practice (BJGP), 73(733), E634-E643. https://doi.org/10.3399/bjgp.2022.0394

• Journal Article Type: Article
• Acceptance Date: Jan 27, 2023
• Online Publication Date: Mar 30, 2023
• Deposit Date: Jun 19, 2023
• Journal: British Journal of General Practice
• Print ISSN: 0960-1643
• Electronic ISSN: 1478-5242
• Publisher: Royal College of General Practitioners
• Peer Reviewed: Peer Reviewed
• Volume: 73
• Issue: 733
• Pages: E634-E643
• DOI: https://doi.org/10.3399/bjgp.2022.0394
• Keywords: antibiotics; burnout; primary care; hazardous prescribing; opioids; patient safety