Antibiotic Prescriptions Associated With COVID-19 Outpatient Visits Among Medicare Beneficiaries, April 2020 to April 2021

Tsay, Sharon; Bartoces, Monina; Gouin, Katryna A; Kabbani, Sarah; Hicks, Lauri A.

doi:10.1001/jama.2022.5471

Cited by 44 publications

(44 citation statements)

References 5 publications

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“…14,15,17,20 Other studies have also described racial and age-related antibiotic prescribing differences prior to and during the pandemic. 23,24 The reasons for these differences are unclear and merit further investigation. These findings could serve as a focus for future stewardship efforts to evaluate whether they relate to clinician or system biases, patient expectations, or some combination of these or other factors.…”

Section: Resultsmentioning

confidence: 99%

Urgent-care antibiotic prescribing: An exploratory analysis to evaluate health inequities

Seibert

Hersh

Patel

et al. 2022

ASHE

Self Cite

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Healthcare disparities and inequities exist in a variety of environments and manifest in diagnostic and therapeutic measures. In this commentary, we highlight our experience examining our organization’s urgent care respiratory encounter antibiotic prescribing practices. We identified differences in prescribing based on several individual characteristics including patient age, race, ethnicity, preferred language, and patient and/or clinician gender. Our approach can serve as an electronic health record (EHR)–based methodology for disparity and inequity audits in other systems and for other conditions.

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Section: Resultsmentioning

confidence: 99%

Urgent-care antibiotic prescribing: An exploratory analysis to evaluate health inequities

Seibert

Hersh

Patel

et al. 2022

ASHE

Self Cite

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“…Several studies have been conducted regarding prevalence of antibiotic prescription and characteristics of acute COVID-19 patients associated with antibiotic prescription 8 – 11 . In a study examining the first year of the pandemic in the US 12 , about 30% of older outpatients with acute COVID-19 received antibiotic prescriptions with male gender and winter season related to a higher rate of prescription. However, there have been few studies which examined prevalence and characteristics of nationwide antibiotic prescription in Japan.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and characteristics of antibiotic prescription for acute COVID-19 patients in Japan

Ventosa¹,

Tokuda

Honda

et al. 2022

Sci Rep

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COVID-19 is a viral infection and does not require antibiotics. The study aimed to elucidate a prescribing pattern of antibiotics for COVID-19. A nationwide cross-sectional study was conducted in Japan. The Diagnosis and Procedure Combinations (DPC) data was used to collect information, covering 25% of all acute care hospitals in the country. In 140,439 COVID-19 patients, 18,550 (13.21%) patients received antibiotics. Antibiotics were prescribed more often in inpatients (10,809 out of 66,912, 16.15%) than outpatients (7741 out of 73,527, 10.53%) (p < 0.001). Outpatient prescription was significantly associated with older patients (odds ratio [OR], 4.66; 95% confidence interval [CI] 4.41–4.93) and a greater Charlson index (OR with one-point index increase, 1.22; 95% CI 1.21–1.23). Inpatient prescription was significantly associated with older patients (OR 2.10; 95% CI 2.01–2.21), male gender (OR 1.12, 95% CI 1.07–1.18), a greater Charlson index (OR with one-point increase, 1.06; 95% CI 1.05–1.07), requirement of oxygen therapy (OR 3.44; 95% CI 3.28–3.60) and mechanical ventilation (OR 15.09; 95% CI 13.60–16.74). The most frequently prescribed antibiotic among outpatients was cefazolin, while that among inpatients was ceftriaxone. Antibiotic prescription is relatively low for acute COVID-19 in Japan. Antibiotic prescription was associated with older age, multi-morbidity, severe disease, and winter season.

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“…Owing in part to the lack of prior literature on the impact of these choices on assessments of antibiotic appropriateness, prior antibiotic prescribing studies and performance measurement programs have used widely varying look-back and look back-and-forward durations, such as 1 day [ 1 ], 2 days [ 2 , 3 , 4 ], 3 days [ 5 , 6 , 7 , 8 , 9 , 10 ], 5 days [ 11 ], 7 days [ 12 , 13 , 14 ], and 30 days [ 15 ]. The impact of these choices on the seeming appropriateness of antibiotic prescribing is unclear and, to our knowledge, has not been previously examined.…”

Section: Introductionmentioning

confidence: 99%

Look-Back and Look-Forward Durations and the Apparent Appropriateness of Ambulatory Antibiotic Prescribing

et al. 2022

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Ambulatory antibiotic stewards, researchers, and performance measurement programs choose different durations to associate diagnoses with antibiotic prescriptions. We assessed how the apparent appropriateness of antibiotic prescribing changes when using different look-back and look-forward periods. Examining durations of 0 days (same-day), −3 days, −7 days, −30 days, ±3 days, ±7 days, and ±30 days, we classified all ambulatory antibiotic prescriptions in the electronic health record of an integrated health care system from 2016 to 2019 (714,057 prescriptions to 348,739 patients by 2391 clinicians) as chronic, appropriate, potentially appropriate, inappropriate, or not associated with any diagnosis. Overall, 16% percent of all prescriptions were classified as chronic infection related. Using only same-day diagnoses, appropriate, potentially appropriate, inappropriate, and not-associated antibiotics, accounted for 14%, 36%, 22%, and 11% of prescriptions, respectively. As the duration of association increased, the proportion of appropriate antibiotics stayed the same (range, 14% to 18%), potentially appropriate antibiotics increased (e.g., 43% for −30 days), inappropriate stayed the same (range, 22% to 24%), and not-associated antibiotics decreased (e.g., 2% for −30 days). Using the longest look-back-and-forward duration (±30 days), appropriate, potentially appropriate, inappropriate, and not-associated antibiotics, accounted for 18%, 44%, 20%, and 2% of prescriptions, respectively. Ambulatory programs and studies focused on appropriate or inappropriate antibiotic prescribing can reasonably use a short duration of association between an antibiotic prescription and diagnosis codes. Programs and studies focused on potentially appropriate antibiotic prescribing might consider examining longer durations.

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Antibiotic Prescriptions Associated With COVID-19 Outpatient Visits Among Medicare Beneficiaries, April 2020 to April 2021

Abstract: Antibiotics are ineffective treatment for viral syndromes, including COVID-19. We characterized antibiotic prescribing in older adults with outpatient COVID-19 visits to identify opportunities to improve prescribing practices.

Cited by 44 publications

References 5 publications

Urgent-care antibiotic prescribing: An exploratory analysis to evaluate health inequities

Urgent-care antibiotic prescribing: An exploratory analysis to evaluate health inequities

Prevalence and characteristics of antibiotic prescription for acute COVID-19 patients in Japan

Look-Back and Look-Forward Durations and the Apparent Appropriateness of Ambulatory Antibiotic Prescribing

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