The association of strong opioids and antibiotics prescribing with general practitioner burnout
Hodkinson A., Zghebi SS., Kontopantelis E., Grigoroglou C., Ashcroft D., Hann M., Chew-Graham CA., Payne RA., Little P., de Lusignan S., Zhou A., Esmail A., Maria P.
Background: Prescribing of strong-opioids and antibiotics has important implications for patient safety. General Practitioner (GP) wellness can affect the overprescribing of both medications in primary care. Aim: To examine the associations between strong opioid and antibiotic prescribing with practice-weighted GP-burnout and wellness scores. Design and Setting: A cross-sectional study using prescription data on strong-opioids/antibiotics from the Oxford-RCGP-RSC linking to a GP-wellbeing survey overlaying the same 4-month period December2019-April2020. Methods: Adult prescriptions were measured as tablets per-patient. Burnout in GPs was measured using the shortened versions of the emotional exhaustion and depersonalisation dimensions. Association was examined by fitting a multilevel generalised-linear-model with negative-binomial distribution. Results: Data for 40,227 patients (13,483 strong opioids and 26,744 antibiotics) were linked to 57 practices and 320 GPs. Greater strong opioid prescribing was associated with increased emotional exhaustion (IRR 1.19, 95%CI 1.10-1.24), depersonalisation (1.10, 1.01-1.16), job dissatisfaction (1.25, 1.19-1.32), diagnostic-uncertainty (1.12, 1.08-1.19) and turnover intention (1.32, 1.27-1.37) in GPs. Greater antibiotic prescribing was associated with increased emotional exhaustion (1.19, 1.05-1.37), depersonalisation (1.24, 1.08-1.49), job dissatisfaction (1.11, 1.04-1.19), sickness-presenteeism (1.18, 1.11-1.25) and turnover intention (1.38, 1.31-1.45) in GPs. Increased strong-opioid and antibiotic prescribing was also found in GPs working longer hours (3.95, 3.39-4.61; 5.02, 4.07-6.19, respectively) and in practices in the north of England (1.96, 1.61-2.33; 1.56, 1.12-3.70, respectively). Conclusion: We found higher rates of prescribing of strong opioids/antibiotics in practices with GPs with more burnout symptoms, job dissatisfaction and turnover intentions, working longer hours and in practices in the north of England serving more deprived populations.