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

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

doi:10.3399/BJGP.2022.0394

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

Br J Gen Pract. 2023 Jul 27;73(733):e634-e643. doi: 10.3399/BJGP.2022.0394. Print 2023 Aug.

Affiliations

¹ NIHR School for Primary Care Research and NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester.
² NIHR School for Primary Care Research, University of Manchester, Manchester.
³ NIHR School for Primary Care Research; Division of Informatics, University of Manchester, Manchester.
⁴ NIHR School for Primary Care Research; Manchester Centre for Health Economics, University of Manchester, Manchester.
⁵ NIHR School for Primary Care Research; NIHR Greater Manchester Patient Safety Translational Research Centre; Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Manchester.
⁶ School of Medicine, Keele University, Keele.
⁷ Exeter Collaboration for Academic Primary Care, University of Exeter Medical School, Exeter.
⁸ Primary Care Research Centre, University of Southampton, Southampton.
⁹ Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford; Royal College of General Practitioners Research and Surveillance Centre, London.

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.

Keywords: antibiotics; burnout; hazardous prescribing; opioids; patient safety; primary care.

MeSH terms

Analgesics, Opioid* / therapeutic use
Anti-Bacterial Agents / therapeutic use
Burnout, Professional* / drug therapy
Burnout, Professional* / epidemiology
Burnout, Professional* / psychology
Cross-Sectional Studies
Humans
Practice Patterns, Physicians'
Retrospective Studies

Substances

Analgesics, Opioid
Anti-Bacterial Agents