Table 1 Open in new tab Distribution of...

Variable	Category (N)	Association with any antibiotic prescription	Association with broad-spectrum antibiotic prescription
Residents	N = 6633
Age (years)	<80 (1498)	Baseline	<.001	Baseline	.02
80 to 89 (2973)	1.12 (1.03–1.21)	1.23 (0.99–1.54)
90+ (2162)	1.28 (1.17–1.40)	1.41 (1.12–1.79)
Sex	Female (4577)	Baseline	.11	Baseline	.01
Male (2056)	1.06 (0.99–1.13)	1.28 (1.07–1.53)
Dementia	No (3539)	Baseline	.37	Baseline	.36
Yes (3094)	1.03 (0.97–1.10)	1.08 (0.91–1.28)
Charlson Comorbidity Index excluding dementia	0 (4216)	Baseline	<.001	Baseline	<.001
1 to 2 (1571)	1.45 (1.34–1.56)	1.78 (1.47–2.16)
3+ (846)	1.86 (1.70–2.05)	2.57 (2.02–3.26)
Care-homes	N = 148
Care type	Nursing (72)	Baseline	.01	Baseline	.22
Residential (76)	1.17 (1.03–1.32)	1.17 (0.91–1.51)
Size (number of beds)	<25 (41)	Baseline	.18	Baseline	.17
25 to 40 (58)	0.97 (0.82–1.14)	1.12 (0.79–1.59)
>40 (49)	0.87 (0.74–1.03)	0.85 (0.60–1.20)
Rurality	Urban (94)	Baseline	.27	Baseline	.08
Small town (28)	0.96 (0.80–1.14)	0.73 (0.50–1.08)
Rural (26)	0.86 (0.72–1.03)	0.68 (0.46–1.02)
Health board	A (90)	Baseline	.01	Baseline	.18
B (58)	1.20 (1.05–1.38)	1.23 (0.91–1.68)
Ownership	Private (118)	Baseline	<.001	Baseline	<.001
Other^a (30)	1.35 (1.15–1.57)	1.84 (1.36–2.48)
General practices with residents registered	1 to 3 (46)	Baseline	.86	Baseline	.89
4 to 8 (60)	0.99 (0.84–1.16)	0.94 (0.67–1.33)
>8 (42)	0.95 (0.80–1.13)	1.01 (0.70–1.47)
Quality overall^b (mean across measures)	Weak (21)	Baseline	.99	Baseline	.47
Good (50)	1.01 (0.83–1.24)	1.21 (0.80–1.82)
Excellent (77)	1.01 (0.84–1.21)	1.27 (0.86–1.88)
Quality: management and leadership^c	Weak (28)	Baseline	.74	Baseline	.39
Good (49)	1.05 (0.88–1.26)	1.29 (0.90–1.86)
Excellent (71)	0.99 (0.84–1.18)	1.18 (0.83–1.67)
Quality: staffing^c	Weak (25)	Baseline	.76	Baseline	.70
Good (49)	0.94 (0.77–1.14)	0.94 (0.64–1.39)
Excellent (74)	0.94 (0.78–1.12)	1.07 (0.75–1.53)
Quality: environment^c	Weak (20)	Baseline	.45	Baseline	.53
Good (57)	0.92 (0.75–1.12)	1.05 (0.71–1.55)
Excellent (71)	1.00 (0.82–1.21)	1.19 (0.82–1.75)
Quality: care and support^c	Weak (26)	Baseline	.45	Baseline	.50
Good (55)	0.94 (0.79–1.13)	1.10 (0.76–1.59)
Excellent (67)	1.03 (0.87–1.23)	1.23 (0.86–1.75)
Complaint(s) upheld in last 3 years	No (66)	Baseline	.01	Baseline	.56
Yes (82)	0.85 (0.75–0.97)	0.93 (0.72–1.20)
Enforced requirement^d in last 3 years	No (90)	Baseline	.82	Baseline	.40
Yes (58)	0.98 (0.86–1.12)	0.89 (0.68–1.16)
Culture sample submission rate (per 1000 RBD)^e	<3.5 (50)	Baseline	<.001	Baseline	<.001
3.5 to 7 (50)	1.12 (0.98–1.29)	1.22 (0.90–1.65)
>7 (48)	1.56 (1.36–1.80)	2.06 (1.49–2.84)
General practices	N = 139
Number of registered patients⁶	<5000 (39)	Baseline	.58	Baseline	.94
5–10 000 (65)	1.02 (0.89–1.15)	1.01 (0.70–1.44)
>10 000 (11)	1.09 (0.91–1.30)	0.93 (0.56–1.56)
Percentage of registered patients aged 65+ years⁷	<20 (59)	Baseline	.86	Baseline	.82
20+ (56)	0.99 (0.89–1.10)	0.97 (0.72–1.30)
Deprivation (% of patients in 15% most deprived postcodes)⁸	0 to 15 (73)	Baseline	.24	Baseline	.11
>15 (42)	1.08 (0.95–1.23)	1.30 (0.94–1.78)
Antibiotic prescriptions (per 1000 patients per year)⁹	≤600 (51)	Baseline	.28	Baseline	.26
>600 (70)	1.06 (0.95–1.17)	1.19 (0.88–1.60)
Patient satisfaction (% positive about overall care)^10,11	<80 (36)	Baseline	.27	Baseline	.82
80 to 89 (41)	0.95 (0.84–1.08)	0.99 (0.70–1.41)
90+ (37)	0.90 (0.79–1.02)	0.90 (0.61–1.31)

Variable

Category (N)

Association with any antibiotic prescription

Association with broad-spectrum antibiotic prescription

IRR (95% CI)

P-value

IRR (95% CI)

P-value

Residents

N = 6633

Age (years)

<80 (1498)

Baseline

<.001

Baseline

.02

80 to 89 (2973)

1.12 (1.03–1.21)

1.23 (0.99–1.54)

90+ (2162)

1.28 (1.17–1.40)

1.41 (1.12–1.79)

Sex

Female (4577)

Baseline

.11

Baseline

.01

Male (2056)

1.06 (0.99–1.13)

1.28 (1.07–1.53)

Dementia

No (3539)

Baseline

.37

Baseline

.36

Yes (3094)

1.03 (0.97–1.10)

1.08 (0.91–1.28)

Charlson Comorbidity Index excluding dementia

0 (4216)

Baseline

<.001

Baseline

<.001

1 to 2 (1571)

1.45 (1.34–1.56)

1.78 (1.47–2.16)

3+ (846)

1.86 (1.70–2.05)

2.57 (2.02–3.26)

Care-homes

N = 148

Care type

Nursing (72)

Baseline

.01

Baseline

.22

Residential (76)

1.17 (1.03–1.32)

1.17 (0.91–1.51)

Size (number of beds)

<25 (41)

Baseline

.18

Baseline

.17

25 to 40 (58)

0.97 (0.82–1.14)

1.12 (0.79–1.59)

>40 (49)

0.87 (0.74–1.03)

0.85 (0.60–1.20)

Rurality

Urban (94)

Baseline

.27

Baseline

.08

Small town (28)

0.96 (0.80–1.14)

0.73 (0.50–1.08)

Rural (26)

0.86 (0.72–1.03)

0.68 (0.46–1.02)

Health board

A (90)

Baseline

.01

Baseline

.18

B (58)

1.20 (1.05–1.38)

1.23 (0.91–1.68)

Ownership

Private (118)

Baseline

<.001

Baseline

<.001

Other^a (30)

1.35 (1.15–1.57)

1.84 (1.36–2.48)

General practices with residents registered

1 to 3 (46)

Baseline

.86

Baseline

.89

4 to 8 (60)

0.99 (0.84–1.16)

0.94 (0.67–1.33)

>8 (42)

0.95 (0.80–1.13)

1.01 (0.70–1.47)

Quality overall^b (mean across measures)

Weak (21)

Baseline

.99

Baseline

.47

Good (50)

1.01 (0.83–1.24)

1.21 (0.80–1.82)

Excellent (77)

1.01 (0.84–1.21)

1.27 (0.86–1.88)

Quality: management and leadership^c

Weak (28)

Baseline

.74

Baseline

.39

Good (49)

1.05 (0.88–1.26)

1.29 (0.90–1.86)

Excellent (71)

0.99 (0.84–1.18)

1.18 (0.83–1.67)

Quality: staffing^c

Weak (25)

Baseline

.76

Baseline

.70

Good (49)

0.94 (0.77–1.14)

0.94 (0.64–1.39)

Excellent (74)

0.94 (0.78–1.12)

1.07 (0.75–1.53)

Quality: environment^c

Weak (20)

Baseline

.45

Baseline

.53

Good (57)

0.92 (0.75–1.12)

1.05 (0.71–1.55)

Excellent (71)

1.00 (0.82–1.21)

1.19 (0.82–1.75)

Quality: care and support^c

Weak (26)

Baseline

.45

Baseline

.50

Good (55)

0.94 (0.79–1.13)

1.10 (0.76–1.59)

Excellent (67)

1.03 (0.87–1.23)

1.23 (0.86–1.75)

Complaint(s) upheld in last 3 years

No (66)

Baseline

.01

Baseline

.56

Yes (82)

0.85 (0.75–0.97)

0.93 (0.72–1.20)

Enforced requirement^d in last 3 years

No (90)

Baseline

.82

Baseline

.40

Yes (58)

0.98 (0.86–1.12)

0.89 (0.68–1.16)

Culture sample submission rate (per 1000 RBD)^e

<3.5 (50)

Baseline

<.001

Baseline

<.001

3.5 to 7 (50)

1.12 (0.98–1.29)

1.22 (0.90–1.65)

>7 (48)

1.56 (1.36–1.80)

2.06 (1.49–2.84)

General practices

N = 139

Number of registered patients⁶

<5000 (39)

Baseline

.58

Baseline

.94

5–10 000 (65)

1.02 (0.89–1.15)

1.01 (0.70–1.44)

>10 000 (11)

1.09 (0.91–1.30)

0.93 (0.56–1.56)

Percentage of registered patients aged 65+ years⁷

<20 (59)

Baseline

.86

Baseline

.82

20+ (56)

0.99 (0.89–1.10)

0.97 (0.72–1.30)

Deprivation (% of patients in 15% most deprived postcodes)⁸

0 to 15 (73)

Baseline

.24

Baseline

.11

>15 (42)

1.08 (0.95–1.23)

1.30 (0.94–1.78)

Antibiotic prescriptions (per 1000 patients per year)⁹

≤600 (51)

Baseline

.28

Baseline

.26

>600 (70)

1.06 (0.95–1.17)

1.19 (0.88–1.60)

Patient satisfaction (% positive about overall care)^10,11

<80 (36)

Baseline

.27

Baseline

.82

80 to 89 (41)

0.95 (0.84–1.08)

0.99 (0.70–1.41)

90+ (37)

0.90 (0.79–1.02)

0.90 (0.61–1.31)

Variable	Category (N)	Association with any antibiotic prescription	Association with broad-spectrum antibiotic prescription
Residents	N = 6633
Age (years)	<80 (1498)	Baseline	<.001	Baseline	.02
80 to 89 (2973)	1.12 (1.03–1.21)	1.23 (0.99–1.54)
90+ (2162)	1.28 (1.17–1.40)	1.41 (1.12–1.79)
Sex	Female (4577)	Baseline	.11	Baseline	.01
Male (2056)	1.06 (0.99–1.13)	1.28 (1.07–1.53)
Dementia	No (3539)	Baseline	.37	Baseline	.36
Yes (3094)	1.03 (0.97–1.10)	1.08 (0.91–1.28)
Charlson Comorbidity Index excluding dementia	0 (4216)	Baseline	<.001	Baseline	<.001
1 to 2 (1571)	1.45 (1.34–1.56)	1.78 (1.47–2.16)
3+ (846)	1.86 (1.70–2.05)	2.57 (2.02–3.26)
Care-homes	N = 148
Care type	Nursing (72)	Baseline	.01	Baseline	.22
Residential (76)	1.17 (1.03–1.32)	1.17 (0.91–1.51)
Size (number of beds)	<25 (41)	Baseline	.18	Baseline	.17
25 to 40 (58)	0.97 (0.82–1.14)	1.12 (0.79–1.59)
>40 (49)	0.87 (0.74–1.03)	0.85 (0.60–1.20)
Rurality	Urban (94)	Baseline	.27	Baseline	.08
Small town (28)	0.96 (0.80–1.14)	0.73 (0.50–1.08)
Rural (26)	0.86 (0.72–1.03)	0.68 (0.46–1.02)
Health board	A (90)	Baseline	.01	Baseline	.18
B (58)	1.20 (1.05–1.38)	1.23 (0.91–1.68)
Ownership	Private (118)	Baseline	<.001	Baseline	<.001
Other^a (30)	1.35 (1.15–1.57)	1.84 (1.36–2.48)
General practices with residents registered	1 to 3 (46)	Baseline	.86	Baseline	.89
4 to 8 (60)	0.99 (0.84–1.16)	0.94 (0.67–1.33)
>8 (42)	0.95 (0.80–1.13)	1.01 (0.70–1.47)
Quality overall^b (mean across measures)	Weak (21)	Baseline	.99	Baseline	.47
Good (50)	1.01 (0.83–1.24)	1.21 (0.80–1.82)
Excellent (77)	1.01 (0.84–1.21)	1.27 (0.86–1.88)
Quality: management and leadership^c	Weak (28)	Baseline	.74	Baseline	.39
Good (49)	1.05 (0.88–1.26)	1.29 (0.90–1.86)
Excellent (71)	0.99 (0.84–1.18)	1.18 (0.83–1.67)
Quality: staffing^c	Weak (25)	Baseline	.76	Baseline	.70
Good (49)	0.94 (0.77–1.14)	0.94 (0.64–1.39)
Excellent (74)	0.94 (0.78–1.12)	1.07 (0.75–1.53)
Quality: environment^c	Weak (20)	Baseline	.45	Baseline	.53
Good (57)	0.92 (0.75–1.12)	1.05 (0.71–1.55)
Excellent (71)	1.00 (0.82–1.21)	1.19 (0.82–1.75)
Quality: care and support^c	Weak (26)	Baseline	.45	Baseline	.50
Good (55)	0.94 (0.79–1.13)	1.10 (0.76–1.59)
Excellent (67)	1.03 (0.87–1.23)	1.23 (0.86–1.75)
Complaint(s) upheld in last 3 years	No (66)	Baseline	.01	Baseline	.56
Yes (82)	0.85 (0.75–0.97)	0.93 (0.72–1.20)
Enforced requirement^d in last 3 years	No (90)	Baseline	.82	Baseline	.40
Yes (58)	0.98 (0.86–1.12)	0.89 (0.68–1.16)
Culture sample submission rate (per 1000 RBD)^e	<3.5 (50)	Baseline	<.001	Baseline	<.001
3.5 to 7 (50)	1.12 (0.98–1.29)	1.22 (0.90–1.65)
>7 (48)	1.56 (1.36–1.80)	2.06 (1.49–2.84)
General practices	N = 139
Number of registered patients⁶	<5000 (39)	Baseline	.58	Baseline	.94
5–10 000 (65)	1.02 (0.89–1.15)	1.01 (0.70–1.44)
>10 000 (11)	1.09 (0.91–1.30)	0.93 (0.56–1.56)
Percentage of registered patients aged 65+ years⁷	<20 (59)	Baseline	.86	Baseline	.82
20+ (56)	0.99 (0.89–1.10)	0.97 (0.72–1.30)
Deprivation (% of patients in 15% most deprived postcodes)⁸	0 to 15 (73)	Baseline	.24	Baseline	.11
>15 (42)	1.08 (0.95–1.23)	1.30 (0.94–1.78)
Antibiotic prescriptions (per 1000 patients per year)⁹	≤600 (51)	Baseline	.28	Baseline	.26
>600 (70)	1.06 (0.95–1.17)	1.19 (0.88–1.60)
Patient satisfaction (% positive about overall care)^10,11	<80 (36)	Baseline	.27	Baseline	.82
80 to 89 (41)	0.95 (0.84–1.08)	0.99 (0.70–1.41)
90+ (37)	0.90 (0.79–1.02)	0.90 (0.61–1.31)

Variable

Category (N)

Association with any antibiotic prescription

Association with broad-spectrum antibiotic prescription

IRR (95% CI)

P-value

IRR (95% CI)

P-value

Residents

N = 6633

Age (years)

<80 (1498)

Baseline

<.001

Baseline

.02

80 to 89 (2973)

1.12 (1.03–1.21)

1.23 (0.99–1.54)

90+ (2162)

1.28 (1.17–1.40)

1.41 (1.12–1.79)

Sex

Female (4577)

Baseline

.11

Baseline

.01

Male (2056)

1.06 (0.99–1.13)

1.28 (1.07–1.53)

Dementia

No (3539)

Baseline

.37

Baseline

.36

Yes (3094)

1.03 (0.97–1.10)

1.08 (0.91–1.28)

Charlson Comorbidity Index excluding dementia

0 (4216)

Baseline

<.001

Baseline

<.001

1 to 2 (1571)

1.45 (1.34–1.56)

1.78 (1.47–2.16)

3+ (846)

1.86 (1.70–2.05)

2.57 (2.02–3.26)

Care-homes

N = 148

Care type

Nursing (72)

Baseline

.01

Baseline

.22

Residential (76)

1.17 (1.03–1.32)

1.17 (0.91–1.51)

Size (number of beds)

<25 (41)

Baseline

.18

Baseline

.17

25 to 40 (58)

0.97 (0.82–1.14)

1.12 (0.79–1.59)

>40 (49)

0.87 (0.74–1.03)

0.85 (0.60–1.20)

Rurality

Urban (94)

Baseline

.27

Baseline

.08

Small town (28)

0.96 (0.80–1.14)

0.73 (0.50–1.08)

Rural (26)

0.86 (0.72–1.03)

0.68 (0.46–1.02)

Health board

A (90)

Baseline

.01

Baseline

.18

B (58)

1.20 (1.05–1.38)

1.23 (0.91–1.68)

Ownership

Private (118)

Baseline

<.001

Baseline

<.001

Other^a (30)

1.35 (1.15–1.57)

1.84 (1.36–2.48)

General practices with residents registered

1 to 3 (46)

Baseline

.86

Baseline

.89

4 to 8 (60)

0.99 (0.84–1.16)

0.94 (0.67–1.33)

>8 (42)

0.95 (0.80–1.13)

1.01 (0.70–1.47)

Quality overall^b (mean across measures)

Weak (21)

Baseline

.99

Baseline

.47

Good (50)

1.01 (0.83–1.24)

1.21 (0.80–1.82)

Excellent (77)

1.01 (0.84–1.21)

1.27 (0.86–1.88)

Quality: management and leadership^c

Weak (28)

Baseline

.74

Baseline

.39

Good (49)

1.05 (0.88–1.26)

1.29 (0.90–1.86)

Excellent (71)

0.99 (0.84–1.18)

1.18 (0.83–1.67)

Quality: staffing^c

Weak (25)

Baseline

.76

Baseline

.70

Good (49)

0.94 (0.77–1.14)

0.94 (0.64–1.39)

Excellent (74)

0.94 (0.78–1.12)

1.07 (0.75–1.53)

Quality: environment^c

Weak (20)

Baseline

.45

Baseline

.53

Good (57)

0.92 (0.75–1.12)

1.05 (0.71–1.55)

Excellent (71)

1.00 (0.82–1.21)

1.19 (0.82–1.75)

Quality: care and support^c

Weak (26)

Baseline

.45

Baseline

.50

Good (55)

0.94 (0.79–1.13)

1.10 (0.76–1.59)

Excellent (67)

1.03 (0.87–1.23)

1.23 (0.86–1.75)

Complaint(s) upheld in last 3 years

No (66)

Baseline

.01

Baseline

.56

Yes (82)

0.85 (0.75–0.97)

0.93 (0.72–1.20)

Enforced requirement^d in last 3 years

No (90)

Baseline

.82

Baseline

.40

Yes (58)

0.98 (0.86–1.12)

0.89 (0.68–1.16)

Culture sample submission rate (per 1000 RBD)^e

<3.5 (50)

Baseline

<.001

Baseline

<.001

3.5 to 7 (50)

1.12 (0.98–1.29)

1.22 (0.90–1.65)

>7 (48)

1.56 (1.36–1.80)

2.06 (1.49–2.84)

General practices

N = 139

Number of registered patients⁶

<5000 (39)

Baseline

.58

Baseline

.94

5–10 000 (65)

1.02 (0.89–1.15)

1.01 (0.70–1.44)

>10 000 (11)

1.09 (0.91–1.30)

0.93 (0.56–1.56)

Percentage of registered patients aged 65+ years⁷

<20 (59)

Baseline

.86

Baseline

.82

20+ (56)

0.99 (0.89–1.10)

0.97 (0.72–1.30)

Deprivation (% of patients in 15% most deprived postcodes)⁸

0 to 15 (73)

Baseline

.24

Baseline

.11

>15 (42)

1.08 (0.95–1.23)

1.30 (0.94–1.78)

Antibiotic prescriptions (per 1000 patients per year)⁹

≤600 (51)

Baseline

.28

Baseline

.26

>600 (70)

1.06 (0.95–1.17)

1.19 (0.88–1.60)

Patient satisfaction (% positive about overall care)^10,11

<80 (36)

Baseline

.27

Baseline

.82

80 to 89 (41)

0.95 (0.84–1.08)

0.99 (0.70–1.41)

90+ (37)

0.90 (0.79–1.02)

0.90 (0.61–1.31)

Table 1

Open in new tab

Distribution of resident, care-home and general practice characteristics, and univariate associations with the likelihood of residents receiving a prescription for any antibiotic, and for a broad-spectrum antibiotic, from negative binomial cross-classified models

Variable	Category (N)	Association with any antibiotic prescription		Association with broad-spectrum antibiotic prescription
Variable	Category (N)	IRR (95% CI)	P-value	IRR (95% CI)	P-value
Residents	N = 6633
Age (years)	<80 (1498)	Baseline	<.001	Baseline	.02
	80 to 89 (2973)	1.12 (1.03–1.21)		1.23 (0.99–1.54)
	90+ (2162)	1.28 (1.17–1.40)		1.41 (1.12–1.79)
Sex	Female (4577)	Baseline	.11	Baseline	.01
Sex	Male (2056)	1.06 (0.99–1.13)	.11	1.28 (1.07–1.53)	.01
Dementia	No (3539)	Baseline	.37	Baseline	.36
Dementia	Yes (3094)	1.03 (0.97–1.10)	.37	1.08 (0.91–1.28)	.36
Charlson Comorbidity Index excluding dementia	0 (4216)	Baseline	<.001	Baseline	<.001
	1 to 2 (1571)	1.45 (1.34–1.56)		1.78 (1.47–2.16)
	3+ (846)	1.86 (1.70–2.05)		2.57 (2.02–3.26)
Care-homes	N = 148
Care type	Nursing (72)	Baseline	.01	Baseline	.22
Care type	Residential (76)	1.17 (1.03–1.32)	.01	1.17 (0.91–1.51)	.22
Size (number of beds)	<25 (41)	Baseline	.18	Baseline	.17
	25 to 40 (58)	0.97 (0.82–1.14)		1.12 (0.79–1.59)
	>40 (49)	0.87 (0.74–1.03)		0.85 (0.60–1.20)
Rurality	Urban (94)	Baseline	.27	Baseline	.08
	Small town (28)	0.96 (0.80–1.14)		0.73 (0.50–1.08)
	Rural (26)	0.86 (0.72–1.03)		0.68 (0.46–1.02)
Health board	A (90)	Baseline	.01	Baseline	.18
Health board	B (58)	1.20 (1.05–1.38)	.01	1.23 (0.91–1.68)	.18
Ownership	Private (118)	Baseline	<.001	Baseline	<.001
Ownership	Other^a (30)	1.35 (1.15–1.57)	<.001	1.84 (1.36–2.48)	<.001
General practices with residents registered	1 to 3 (46)	Baseline	.86	Baseline	.89
	4 to 8 (60)	0.99 (0.84–1.16)		0.94 (0.67–1.33)
	>8 (42)	0.95 (0.80–1.13)		1.01 (0.70–1.47)
Quality overall^b (mean across measures)	Weak (21)	Baseline	.99	Baseline	.47
	Good (50)	1.01 (0.83–1.24)		1.21 (0.80–1.82)
	Excellent (77)	1.01 (0.84–1.21)		1.27 (0.86–1.88)
Quality: management and leadership^c	Weak (28)	Baseline	.74	Baseline	.39
	Good (49)	1.05 (0.88–1.26)		1.29 (0.90–1.86)
	Excellent (71)	0.99 (0.84–1.18)		1.18 (0.83–1.67)
Quality: staffing^c	Weak (25)	Baseline	.76	Baseline	.70
	Good (49)	0.94 (0.77–1.14)		0.94 (0.64–1.39)
	Excellent (74)	0.94 (0.78–1.12)		1.07 (0.75–1.53)
Quality: environment^c	Weak (20)	Baseline	.45	Baseline	.53
	Good (57)	0.92 (0.75–1.12)		1.05 (0.71–1.55)
	Excellent (71)	1.00 (0.82–1.21)		1.19 (0.82–1.75)
Quality: care and support^c	Weak (26)	Baseline	.45	Baseline	.50
	Good (55)	0.94 (0.79–1.13)		1.10 (0.76–1.59)
	Excellent (67)	1.03 (0.87–1.23)		1.23 (0.86–1.75)
Complaint(s) upheld in last 3 years	No (66)	Baseline	.01	Baseline	.56
Complaint(s) upheld in last 3 years	Yes (82)	0.85 (0.75–0.97)	.01	0.93 (0.72–1.20)	.56
Enforced requirement^d in last 3 years	No (90)	Baseline	.82	Baseline	.40
Enforced requirement^d in last 3 years	Yes (58)	0.98 (0.86–1.12)	.82	0.89 (0.68–1.16)	.40
Culture sample submission rate (per 1000 RBD)^e	<3.5 (50)	Baseline	<.001	Baseline	<.001
	3.5 to 7 (50)	1.12 (0.98–1.29)		1.22 (0.90–1.65)
	>7 (48)	1.56 (1.36–1.80)		2.06 (1.49–2.84)
General practices	N = 139
Number of registered patients⁶	<5000 (39)	Baseline	.58	Baseline	.94
	5–10 000 (65)	1.02 (0.89–1.15)		1.01 (0.70–1.44)
	>10 000 (11)	1.09 (0.91–1.30)		0.93 (0.56–1.56)
Percentage of registered patients aged 65+ years⁷	<20 (59)	Baseline	.86	Baseline	.82
Percentage of registered patients aged 65+ years⁷	20+ (56)	0.99 (0.89–1.10)	.86	0.97 (0.72–1.30)	.82
Deprivation (% of patients in 15% most deprived postcodes)⁸	0 to 15 (73)	Baseline	.24	Baseline	.11
Deprivation (% of patients in 15% most deprived postcodes)⁸	>15 (42)	1.08 (0.95–1.23)	.24	1.30 (0.94–1.78)	.11
Antibiotic prescriptions (per 1000 patients per year)⁹	≤600 (51)	Baseline	.28	Baseline	.26
Antibiotic prescriptions (per 1000 patients per year)⁹	>600 (70)	1.06 (0.95–1.17)	.28	1.19 (0.88–1.60)	.26
Patient satisfaction (% positive about overall care)^10,11	<80 (36)	Baseline	.27	Baseline	.82
	80 to 89 (41)	0.95 (0.84–1.08)		0.99 (0.70–1.41)
	90+ (37)	0.90 (0.79–1.02)		0.90 (0.61–1.31)

Variable	Category (N)	Association with any antibiotic prescription		Association with broad-spectrum antibiotic prescription
Variable	Category (N)	IRR (95% CI)	P-value	IRR (95% CI)	P-value
Residents	N = 6633
Age (years)	<80 (1498)	Baseline	<.001	Baseline	.02
	80 to 89 (2973)	1.12 (1.03–1.21)		1.23 (0.99–1.54)
	90+ (2162)	1.28 (1.17–1.40)		1.41 (1.12–1.79)
Sex	Female (4577)	Baseline	.11	Baseline	.01
Sex	Male (2056)	1.06 (0.99–1.13)	.11	1.28 (1.07–1.53)	.01
Dementia	No (3539)	Baseline	.37	Baseline	.36
Dementia	Yes (3094)	1.03 (0.97–1.10)	.37	1.08 (0.91–1.28)	.36
Charlson Comorbidity Index excluding dementia	0 (4216)	Baseline	<.001	Baseline	<.001
	1 to 2 (1571)	1.45 (1.34–1.56)		1.78 (1.47–2.16)
	3+ (846)	1.86 (1.70–2.05)		2.57 (2.02–3.26)
Care-homes	N = 148
Care type	Nursing (72)	Baseline	.01	Baseline	.22
Care type	Residential (76)	1.17 (1.03–1.32)	.01	1.17 (0.91–1.51)	.22
Size (number of beds)	<25 (41)	Baseline	.18	Baseline	.17
	25 to 40 (58)	0.97 (0.82–1.14)		1.12 (0.79–1.59)
	>40 (49)	0.87 (0.74–1.03)		0.85 (0.60–1.20)
Rurality	Urban (94)	Baseline	.27	Baseline	.08
	Small town (28)	0.96 (0.80–1.14)		0.73 (0.50–1.08)
	Rural (26)	0.86 (0.72–1.03)		0.68 (0.46–1.02)
Health board	A (90)	Baseline	.01	Baseline	.18
Health board	B (58)	1.20 (1.05–1.38)	.01	1.23 (0.91–1.68)	.18
Ownership	Private (118)	Baseline	<.001	Baseline	<.001
Ownership	Other^a (30)	1.35 (1.15–1.57)	<.001	1.84 (1.36–2.48)	<.001
General practices with residents registered	1 to 3 (46)	Baseline	.86	Baseline	.89
	4 to 8 (60)	0.99 (0.84–1.16)		0.94 (0.67–1.33)
	>8 (42)	0.95 (0.80–1.13)		1.01 (0.70–1.47)
Quality overall^b (mean across measures)	Weak (21)	Baseline	.99	Baseline	.47
	Good (50)	1.01 (0.83–1.24)		1.21 (0.80–1.82)
	Excellent (77)	1.01 (0.84–1.21)		1.27 (0.86–1.88)
Quality: management and leadership^c	Weak (28)	Baseline	.74	Baseline	.39
	Good (49)	1.05 (0.88–1.26)		1.29 (0.90–1.86)
	Excellent (71)	0.99 (0.84–1.18)		1.18 (0.83–1.67)
Quality: staffing^c	Weak (25)	Baseline	.76	Baseline	.70
	Good (49)	0.94 (0.77–1.14)		0.94 (0.64–1.39)
	Excellent (74)	0.94 (0.78–1.12)		1.07 (0.75–1.53)
Quality: environment^c	Weak (20)	Baseline	.45	Baseline	.53
	Good (57)	0.92 (0.75–1.12)		1.05 (0.71–1.55)
	Excellent (71)	1.00 (0.82–1.21)		1.19 (0.82–1.75)
Quality: care and support^c	Weak (26)	Baseline	.45	Baseline	.50
	Good (55)	0.94 (0.79–1.13)		1.10 (0.76–1.59)
	Excellent (67)	1.03 (0.87–1.23)		1.23 (0.86–1.75)
Complaint(s) upheld in last 3 years	No (66)	Baseline	.01	Baseline	.56
Complaint(s) upheld in last 3 years	Yes (82)	0.85 (0.75–0.97)	.01	0.93 (0.72–1.20)	.56
Enforced requirement^d in last 3 years	No (90)	Baseline	.82	Baseline	.40
Enforced requirement^d in last 3 years	Yes (58)	0.98 (0.86–1.12)	.82	0.89 (0.68–1.16)	.40
Culture sample submission rate (per 1000 RBD)^e	<3.5 (50)	Baseline	<.001	Baseline	<.001
	3.5 to 7 (50)	1.12 (0.98–1.29)		1.22 (0.90–1.65)
	>7 (48)	1.56 (1.36–1.80)		2.06 (1.49–2.84)
General practices	N = 139
Number of registered patients⁶	<5000 (39)	Baseline	.58	Baseline	.94
	5–10 000 (65)	1.02 (0.89–1.15)		1.01 (0.70–1.44)
	>10 000 (11)	1.09 (0.91–1.30)		0.93 (0.56–1.56)
Percentage of registered patients aged 65+ years⁷	<20 (59)	Baseline	.86	Baseline	.82
Percentage of registered patients aged 65+ years⁷	20+ (56)	0.99 (0.89–1.10)	.86	0.97 (0.72–1.30)	.82
Deprivation (% of patients in 15% most deprived postcodes)⁸	0 to 15 (73)	Baseline	.24	Baseline	.11
Deprivation (% of patients in 15% most deprived postcodes)⁸	>15 (42)	1.08 (0.95–1.23)	.24	1.30 (0.94–1.78)	.11
Antibiotic prescriptions (per 1000 patients per year)⁹	≤600 (51)	Baseline	.28	Baseline	.26
Antibiotic prescriptions (per 1000 patients per year)⁹	>600 (70)	1.06 (0.95–1.17)	.28	1.19 (0.88–1.60)	.26
Patient satisfaction (% positive about overall care)^10,11	<80 (36)	Baseline	.27	Baseline	.82
	80 to 89 (41)	0.95 (0.84–1.08)		0.99 (0.70–1.41)
	90+ (37)	0.90 (0.79–1.02)		0.90 (0.61–1.31)

^aOther ownership = local authority or voluntary service.

^bOverall quality = mean of four quality measures (each out of 6): weak <3.5; good 3.5 to <4.5; excellent ≥4.5.

^cIndividual quality measures (out of 6): weak = 1, 2, 3; good = 4; excellent = 5, 6.

^dChanges mandated following inspection by the Care Inspectorate.

^eRBD, resident bed-days.

^fGP practice data were missing for 24^6,7,8, 18⁹ and 25¹⁰ practices.

^gPercentage (weighted) of respondents rating the overall care provided by their GP practice as Excellent or Good.

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