Outpatient Antibiotic Use and the Need for Increased Antibiotic Stewardship Efforts

Zetts, Rachel M; Stoesz, Andrea; Smith, Brian A.; Hyun, David Y.

doi:10.1542/peds.2017-4124

Cited by 70 publications

(66 citation statements)

References 55 publications

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“…One of the main risk factors for AMR in the United States is inappropriate prescription of antimicrobial therapies by primary care providers ( Zetts et al, ) . Researchers have found that approximately 154 million primary care visits in the United States result in an antibiotic prescription and approximately 30 per cent, or 47 million, of these prescriptions are not necessary (PEW, ).…”

Section: Introductionmentioning

confidence: 99%

“…Researchers have shown that patients’ demand for antimicrobial therapies varies depending on cultural background and geographic location (Larson et al, ; Morgan & Hart, ; Zetts et al, ). Researchers have found Hispanic cultures request antibiotics more frequently (Larson et al, ).…”

Section: Introductionmentioning

confidence: 99%

“…Drug‐resistance infections contribute to longer hospital stays, higher medical costs and increased incidence of morbidity (World Health Organization, ; Zetts, Stoesz, Smith, & Hyun, ). Though there is advocacy for the prevention of AMR, interventions have enjoyed limited success because of primary care providers’ fears and patient's perceived demand for pills to treat all illnesses (Martínez‐González et al, ; Wood et al, ).…”

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confidence: 99%

“…Though there is advocacy for the prevention of AMR, interventions have enjoyed limited success because of primary care providers’ fears and patient's perceived demand for pills to treat all illnesses (Martínez‐González et al, ; Wood et al, ). For instance, primary care providers want to meet the patients’ need to feel satisfied with their care (Martínez‐González et al, ; Wood et al, ; Zetts et al, ). Primary care providers also may fear that patients may become ill without the use of antimicrobial therapies (Martínez‐González et al, ; Wood et al, ; Zetts et al, ).…”

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confidence: 99%

“…For instance, primary care providers want to meet the patients’ need to feel satisfied with their care (Martínez‐González et al, ; Wood et al, ; Zetts et al, ). Primary care providers also may fear that patients may become ill without the use of antimicrobial therapies (Martínez‐González et al, ; Wood et al, ; Zetts et al, ). AMR needs to be combated with primary levels of prevention by nurses.…”

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Antimicrobial resistance needs to be combated at primary levels of prevention by nurses

Oerther

2020

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Antimicrobial resistance needs to be combated at primary levels of prevention by nurses

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2020

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Trends in Pediatric Primary Care Visits Among Commercially Insured US Children, 2008-2016

et al. 2020

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IMPORTANCE Primary care is the foundation of pediatric care. While policy interventions have focused on improving access and quality of primary care, trends in overall use of primary care among children have not been described.OBJECTIVE To assess trends in primary care visit rates and out-of-pocket costs, to examine variation in these trends by patient and visit characteristics, and to assess shifts to alternative care options (eg, retail clinics, urgent care, and telemedicine). DESIGN, SETTING, AND PARTICIPANTSObservational cohort study of claims data from 2008 to 2016 for children 17 years and younger covered by a large national commercial health plan. Visit rate per 100 child-years was determined for each year overall, by child and geographic characteristics, and by visit type (eg, primary diagnosis), and trends were assessed with a series of child-year Poisson models. Data were analyzed from November 2017 to September 2019. MAIN OUTCOMES AND MEASURESVisits to primary care and other settings.RESULTS This cohort study included more than 71 million pediatric primary care visits over 29 million pediatric child-years (51% male in 2008 and 2016; 37% between 12-17 years in 2008 and 38% between 12-17 years in 2016). Unadjusted results for primary care visit rates per 100 child-years decreased from 259.6 in 2008 to 227.2 in 2016, yielding a regression-estimated change in primary care visits across the 9 years of −14.4% (95% CI, −15.0% to −13.9%; absolute change: −32.4 visits per 100 child-years). After controlling for shifts in demographics, the relative decrease was −12.8% (95% CI, −13.3% to −12.2%). Preventive care visits per 100 child-years increased from 74.9 in 2008 to 83.2 visits in 2016 (9.9% change in visit rate; 95% CI, 9.0%-10.9%; absolute change: 8.3 visits per 100 child-years), while problem-based visits per 100 child-years decreased from 184.7 in 2008 to 144.1 in 2016 (−24.1%; 95% CI, −24.6% to −23.5%; absolute change: −40.6 visits per 100 child-years). Visit rates decreased for all diagnostic groups except for the behavioral and psychiatric category. Out-of-pocket costs for problem-based primary care visits increased by 42% during the same period. Per 100 child-years, visits to other acute care venues increased from 21.3 to 27.6 (30.3%; 95% CI, 28.5% to 32.1%; absolute change: 6.3 visits per 100 child-years) and visits to specialists from 45.2 to 53.5 (16.4%; 95% CI, 14.8% to 18.0%, absolute change: 8.3 visits per 100 child-years).CONCLUSIONS AND RELEVANCE Primary care visit rates among commercially insured children decreased over the last decade. Increases in out-of-pocket costs and shifts to other venues appear to explain some of this decrease.

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National Trends in Oral Antibiotic Prescribing in United States Physician Offices from 2009 to 2016

et al. 2020

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BACKGROUND Prior studies have found that outpatient antibiotics are commonly prescribed for nonbacterial conditions. It is unclear if national prescribing has changed in recent years given recent public health and antimicrobial stewardship initiatives. This study aimed to describe antibiotic prescribing in United States (U.S.) physician offices. MATERIALS/METHODS This was a cross-sectional study of all sampled patient visits in the Centers for Disease Control and Prevention's National Ambulatory Medical Care Survey from 2009 to 2016. Antibiotic use was defined as at least one oral antibiotic prescription during the visit as identified by Multum code(s). Patient visits were categorized by U.S. geographic region and season. ICD-9-CM and ICD-10 codes were used to assess diagnoses and categorize antibiotic use as appropriate, possibly appropriate, or inappropriate. RESULTS Seven billion visits were included for analysis, with 793,415,182 (11.3%) including an antibiotic. Prescribing rates were relatively stable over the study period (102.9-124.9 prescriptions per 1000 visits); however, 2016 had one of the lowest prescribing rates (107.7 per 1000 visits). The most commonly prescribed antibiotic class was macrolides (25 per 1000 visits). The South region and winter season had the highest antibiotic prescribing (118.2 and 129.7 per 1000 visits, respectively). Of patients who received an antibiotic, 55.9%, 35.7%, and 8.4% were classified as inappropriate, possibly appropriate, and appropriate, respectively. The most common conditions in which antibiotics were prescribed inappropriately included those with no indication in any of the predefined diagnosis codes (40.1%), other skin conditions (17.3%), and viral upper respiratory conditions (13.3%). CONCLUSIONS There was no significant reduction in outpatient antibiotic prescribing rates among U.S. outpatients from 2009 to 2016 and prescribing varied by region and season. These data suggest that more than half of antibiotics were prescribed inappropriately, with the majority of antibiotics prescribed with no indication. However, these findings need to be confirmed with robust prospective studies.

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Outpatient Antibiotic Use and the Need for Increased Antibiotic Stewardship Efforts

Cited by 70 publications

References 55 publications

Antimicrobial resistance needs to be combated at primary levels of prevention by nurses

Antimicrobial resistance needs to be combated at primary levels of prevention by nurses

Trends in Pediatric Primary Care Visits Among Commercially Insured US Children, 2008-2016

National Trends in Oral Antibiotic Prescribing in United States Physician Offices from 2009 to 2016

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