30 | Nursing in Practice | Summer 2023

RESEARCH UPDATE

A recent study examined the rate of amoxicillin prescribing among infants and its potential contribution to antimicrobial resistance , while another considered remote primary care for homeless people during the pandemic

Factors predicting amoxicillin prescribing in primary care among children : a cohort study 1 Each year in England , around a third of under-fives are prescribed at least one antibiotic 2 , and three-quarters of antibiotics prescribed to children in primary care are for respiratory tract infections ( RTIs ). 3 , 4 Antibiotic prescribing contributes to antimicrobial resistance , which is a public health emergency . 5

Miller and colleagues ( 2022 ) 1 aimed to identify factors associated with amoxicillin prescribing and consultation for RTIs in primary care among young children . They undertook a cohort study in the city of Bradford in northern England with data from pregnancy to 24 months of age , collected between 2007-2013 from electronic primary care and air pollution data . They calculated the prescribing rates per 1,000 child-years to establish risk factors for amoxicillin prescribing and RTI consultation during the first two years of life .

Among 2,493 children studied , the amoxicillin prescribing rate was 710 / 1,000 child-years during the first year and 780 / 1,000 during the second year . Prescribing during year one was increased for infants who were male , socio-economically deprived and had a Pakistani ethnic background ( around 27 % of Bradford ’ s population are of south Asian heritage ). The chances of being prescribed amoxicillin during the second year were higher for infants with a Pakistani ethnic background and pre- / early-term infants . Additional risk factors for antibiotic prescribing included caesarean delivery , congenital irregularities , overcrowded households and attending a childcare setting .

Overall , this research suggests a child ’ s socioeconomic status and ethnic background are strongly associated with amoxicillin prescribing and consultations for RTIs in primary care during childhood . Its main limitation is that the data were gathered from families living in Bradford , and therefore may not be generalisable throughout the country .

Active interventions aimed at reducing the spread of respiratory tract infections in household and childcare settings may reduce antibiotic prescribing , which will assist antimicrobial stewardship in primary care .

Reference 1 Miller , F et al . ( 2022 ) Factors predicting amoxicillin prescribing in primary care among children : a cohort study . BJGP ; 2022 ; 72 ( 722 ): e659 – 67 . DOI : 10.3399 / BJGP . 2021.0639 . tinyurl . com / Miller-amoxicillin

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Lucille Kelsall-Knight is a lecturer in children ’ s nursing at University of Birmingham School of Nursing

Remote primary care during the Covid-19 pandemic for people experiencing homelessness : a qualitative study 1 Homelessness is a growing problem in England and other UK countries . 2 Recent evidence shows widening health inequalities for homeless people , who face acute and ongoing complex mental , social and physical care needs . 3 The NHS Long Term Plan ( 2019 ) seeks to address inequalities , recommending prioritisation of vulnerable groups in primary care 4 , but the pandemic forced changes in primary care . Remote consultations have become common , including for homeless people , possibly exacerbating inequality of access .

Howells and colleagues ( 2022 ) 1 set out to explore the experience and impact of the changes in primary care in response to Covid-19 , focusing on access to healthcare for people experiencing homelessness . They undertook individual semi-structured interviews with 21 homeless people , and 22 clinicians and support workers , at three case study sites between September 2020 and the end of January 2021 . The sites were two commissioned primary care services and a community nurse inclusion service .

The interviews revealed difficulties accessing healthcare for homeless people , who did not always have access to a phone or the means to pay for a phone call . This meant additional work for support workers and clinicians in the community to provide or facilitate an appointment . The study participants felt there were challenges in maintaining a therapeutic relationship when conducting care remotely . Some felt remote appointments facilitated repeat prescriptions , but removed the ability to ‘ drop in ’ at their GP practice or day centre for a same-day appointment .

The main limitation of the study was that it only collected qualitative data ; quantitative data may have provided more evidence on modes of consultation and the number of appointments .

The study concludes remote care should not be the default approach , despite having some advantages . Patients ’ vulnerability and their clinical needs should be taken into consideration , as a relationship-based approach is important to addressing inequalities . Working as a homelessness outreach nurse , page 22

Reference 1 Howells , K et al . ( 2022 ) Remote primary care during the Covid-19 pandemic for people experiencing homelessness : a qualitative study . BJGP 2022 ; 72 ( 720 ): e492-e500 . DOI : 10.3399 / BJGP . 2021.0596 . tinyurl . com / Howells-remote

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