Characteristics of Primary Care Physicians Associated With High Outpatient Antibiotic Prescribing Volume

Fleming-Dutra, Katherine E.; Bartoces, Monina; Roberts, Rebecca M.; Hicks, Lauri A.

doi:10.1093/ofid/ofx279

Cited by 26 publications

(29 citation statements)

References 8 publications

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“…Although the literature continues to demonstrate ongoing issues with unnecessary antibiotic exposure for ARIs and risk factors for inappropriate prescribing in the outpatient setting, [17][18][19][20][21][22] a paucity of data exists on the impact of residents on antibiotic use in primary care. Gaur et al 25 reported that during outpatient visits for a diagnosis suggestive of a viral URI in children, antibiotic prescribing occurred more commonly among attending staff physicians than trainees (36.5% vs 19.5%; OR, 0.44; 95% CI, 0.33-0.59).…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have attempted to determine risk factors for unnecessary antibiotic prescribing in the outpatient setting [17][18][19][20][21][22] ; however, a paucity of data exists for antibiotic prescribing practices at residency-based primary care settings, which have unique forces impacting the practice of evidenced-based medicine. Before implementing ASP initiatives to optimize ARI-associated antibiotic use within the Allegheny Health Network (AHN), we aimed to identify characteristics associated with inappropriate antibiotic prescribing for ARIs among physicians in internal medicine (IM) residencyebased primary care offices.…”

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confidence: 99%

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Risk Factors for Unnecessary Antibiotic Prescribing for Acute Respiratory Tract Infections in Primary Care

Walsh

Taffe

Sacca

et al. 2020

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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Objective: To determine independent risk factors for inappropriate antibiotic prescribing for acute respiratory tract infections (ARIs) in internal medicine (IM) residencyebased primary care offices. Patients and Methods: A retrospective study was conducted to measure antibiotic prescribing rates, and multivariable analysis was utilized to identify predictors of inappropriate prescribing among patients presenting to IM residencyebased primary care office practices. Patients with an office visit at either of 2 IM residencyebased primary care office practices from January 1, 2016, through December 31, 2016, with a primary encounter diagnosis of ARI were included. Results: During the study period, 911 unique patient encounters were included with 518 for conditions for which antibiotics were considered always inappropriate. Antibiotics were not indicated in 85.8% (782 of 911) of encounters. However, antibiotics were prescribed in 28.4% (222 of 782) of these encounters. Inappropriate antibiotic prescribing occurred in 111 of 518 (21.4%) encounters for conditions for which antibiotics are always inappropriate. Using multivariable logistic regression analysis to assess for independent risk factors when adjusted for other potential risk factors for office visits at which antibiotics were not indicated, IM residenteassociated visits (odds ratio, 0.25; 95% CI, 0.18-0.36) was the only variable independently associated with lower risk of inappropriate antibiotic prescribing.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Risk Factors for Unnecessary Antibiotic Prescribing for Acute Respiratory Tract Infections in Primary Care

Walsh

Taffe

Sacca

et al. 2020

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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“…Our study's findings are consistent with previous studies' antibiotic prescribing rates for acute upper respiratory infections, in that rates still remain high over recent years. [18][19][20] The correlation between provider characteristics and increased antibiotic use is explained by a range of factors, such as the importance placed on patient satisfaction surveys, years of practice, time pressures, and longstanding relationships between the provider and patient. 2,[20][21][22][23][24][25] In our study, physician specialists and providers 35 years of age were significantly less likely to prescribe antibiotics in AAB, likely explained by the notion that physician specialists are not typically first-line providers who treat uncomplicated AAB.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, there have been more endorsements from medical organizations and societies that highlight the importance of appropriate antibiotic use in the outpatient setting. 20,26 The patient-level characteristics identified in this study serve as a general description of the patient population at Baylor Scott & White Health who required medical care for a common viral diagnosis. This can be a useful baseline when evaluating trends and patterns from a patient-level perspective over time.…”

Section: Discussionmentioning

confidence: 99%

Patient and provider characteristics and outcomes associated with outpatient antibiotic overuse in acute adult bronchitis

Li¹,

Conson²,

Kim

et al. 2020

Baylor University Medical Center Proceedings

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Nonbacterial acute bronchitis leads to many outpatient clinic visits in the US that result in an antibiotic prescription. Understanding antibiotic prescribing patterns and their clinical consequences will help improve antimicrobial stewardship efforts. A retrospective chart review was conducted to identify any correlations between patient and provider characteristics with antibiotic use in adult acute bronchitis (AAB) and to compare the clinical outcomes and rates of health care utilization between those who did and did not receive antibiotics. Study participants included adults with uncomplicated AAB seen by family medicine or internal medicine, specialty, and mid-level practitioners in a Baylor Scott & White Health outpatient facility. Phase 1 investigated whether prescribing rates varied by provider-or patient-level characteristics. Phase 2 compared clinical outcomes and health care utilization between patients who received an antibiotic versus those who did not receive an antibiotic for AAB. Among 35,383 visits for AAB, 81.4% resulted in a prescription for an antibiotic. Physicians >35 years of age and internal and family medicine physicians were more likely to prescribe antibiotics. Health care utilization rates did not differ between cohorts. The number of Clostridium difficile events was negligible. KEYWORDS Acute bronchitis; community-acquired Clostridium difficile; health care utilization; outpatient antibiotics; upper respiratory tract infection A cute respiratory tract infections are the leading drivers in outpatient visits in the US. 1 Nearly 68 million outpatient visits for this diagnosis per year result in an antibiotic prescription, and 50% of those antibiotics may be unnecessary. 2 Uncomplicated adult acute bronchitis (AAB) is diagnosed after ruling out risk factors such as asthma, chronic obstructive pulmonary disease, heart failure, and pneumonia in patients with productive or nonproductive cough lasting up to 6 weeks. 3 Evidence from 40 years of studies has shown the lack of efficacy of antibiotics in AAB, 4,5 as bacteria are detected in only 1% to 10% of AAB cases. 3 Thus, professional societies and medical organizations strongly recommended against antibiotic use in uncomplicated AAB. 2,3 6-9 Despite this, antibiotics were still prescribed in about 70% of AAB visits from 1996 to 2010,

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“…IQVIA data are the most complete source of outpatient population-based antibiotic data in many jurisdictions. 4,12,21,40 However, this database has not been externally validated and it is possible that the estimates of antibiotic use were less precise in certain regions with poorer coverage. Pharmacy dispensing data may not accurately represent antibiotic consumption as patient adherence can vary.…”

Section: Limitationsmentioning

confidence: 99%

Regional variability in outpatient antibiotic use in Ontario, Canada: a retrospective cross-sectional study

Schwartz¹,

Achonu²,

Brown³

et al. 2018

cmajo

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Background: Regional variability in antibiotic use is associated with both antibiotic overuse and antimicrobial resistance. Our objectives were to benchmark outpatient antibiotic use and to evaluate geographic variability among health regions in the province of Ontario, Canada. Methods: This was a cross-sectional study of antibiotics dispensed from outpatient retail pharmacies in Ontario between March 2016 and February 2017. We analyzed variability in the number of antibiotic prescriptions dispensed per 1000 population among Ontario's 14 health regions with crude and adjusted Poisson regression models. Adjusted models controlled for rurality, 4 physician characteristics and 6 population characteristics. Results: There were 8 352 578 antibiotics dispensed during the 1-year study period or 621 per 1000 population. The most commonly prescribed antibiotic classes were narrow-spectrum penicillins, macrolides, first-generation cephalosporins and second-generation fluoroquinolones, with adult women receiving the highest rate of prescriptions: 985 antibiotic prescriptions per 1000 population. There was geographic variability in total and class-specific antibiotic use. In the health region with the highest use 778 antibiotics were dispensed per 1000 population whereas in the health region with the lowest use 534 antibiotics were dispensed per 1000 population. The adjusted marginal standardized antibiotic prescription rates for the health regions with the highest and lowest use were 787 (95% confidence interval [CI] 658-934) and 546 (95% CI 494-606) antibiotic prescriptions per 1000 population, respectively. Interpretation: We described baseline antibiotic usage in Ontario over a 12-month period, noting variability among some health regions. Our findings highlight the need for interventions to optimize antibiotic use and slow the emergence of antimicrobial resistance.

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Characteristics of Primary Care Physicians Associated With High Outpatient Antibiotic Prescribing Volume

Cited by 26 publications

References 8 publications

Risk Factors for Unnecessary Antibiotic Prescribing for Acute Respiratory Tract Infections in Primary Care

Risk Factors for Unnecessary Antibiotic Prescribing for Acute Respiratory Tract Infections in Primary Care

Patient and provider characteristics and outcomes associated with outpatient antibiotic overuse in acute adult bronchitis

Regional variability in outpatient antibiotic use in Ontario, Canada: a retrospective cross-sectional study

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