2019
DOI: 10.1371/journal.pone.0223097
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Validating a popular outpatient antibiotic database to reliably identify high prescribing physicians for patients 65 years of age and older

Abstract: ObjectiveMany jurisdictions lack comprehensive population-based antibiotic use data and rely on third party companies, most commonly IQVIA. Our objective was to validate the accuracy of the IQVIA Xponent antibiotic database in identifying high prescribing physicians compared to the reference standard of a highly accurate population-wide database of outpatient antimicrobial dispensing for patients ≥65 years.MethodsWe conducted this study between 1 March 2016 and 28 February 2017 in Ontario, Canada. We evaluated… Show more

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Cited by 18 publications
(18 citation statements)
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“…Compared with other Australian settings, narrow spectrum antimicrobials were more commonly prescribed with high appropriateness of use (WA: 91%; NT: 82%; QLD: 65%). The dominant treatment indications were skin and soft tissue infections (WA: 35%; NT: 29%; QLD: 40%) [ 77 ] Hui 2015 Mathematical model Diagnostic Test Accuracy Test (7/10) Australia Simulated remote indigenous community Individual-based mathematical model to determine the impact of molecular testing on AMR surveillance of gonorrhoea Time delay between first importation and the first confirmation that the prevalence of gonorrhoea AMR has breached the 5% threshold (when a change in antibiotic should occur) In the best-case scenario, the alert would be triggered within 3–6 months of the resistance proportion exceeding the 5% threshold, at least 8 months earlier than using culture alone Mixed urban and rural [ 78 ] Schwartz 2019 Database validation Diagnostic Test Accuracy Test (6/10) Canada 9272 physicians prescribing antibiotics to patients ≥ 65 years in urban (90.3%) and rural (9.7%) locations of practice IQVIA Xponent database of dispensed antibiotic prescription counts aggregated at the physician prescriber-level Agreement and correlation between Xponent and Ontario Drug Benefit database, performance characteristics for Xponent to accurately identify high prescribing physicians The Xponent database has a specificity of 92.4% (95% CI 92.0–92.8%) and PPV of 77.2% (95% CI 76.0–78.4%) for correctly identifying the top 25th percentile of physicians by antibiotic volume. In the sensitivity analysis, 94% of the top 25th percentile physicians in Xponent were within the top 40th percentile in the reference database.…”
Section: Methodsmentioning
confidence: 99%
“…Compared with other Australian settings, narrow spectrum antimicrobials were more commonly prescribed with high appropriateness of use (WA: 91%; NT: 82%; QLD: 65%). The dominant treatment indications were skin and soft tissue infections (WA: 35%; NT: 29%; QLD: 40%) [ 77 ] Hui 2015 Mathematical model Diagnostic Test Accuracy Test (7/10) Australia Simulated remote indigenous community Individual-based mathematical model to determine the impact of molecular testing on AMR surveillance of gonorrhoea Time delay between first importation and the first confirmation that the prevalence of gonorrhoea AMR has breached the 5% threshold (when a change in antibiotic should occur) In the best-case scenario, the alert would be triggered within 3–6 months of the resistance proportion exceeding the 5% threshold, at least 8 months earlier than using culture alone Mixed urban and rural [ 78 ] Schwartz 2019 Database validation Diagnostic Test Accuracy Test (6/10) Canada 9272 physicians prescribing antibiotics to patients ≥ 65 years in urban (90.3%) and rural (9.7%) locations of practice IQVIA Xponent database of dispensed antibiotic prescription counts aggregated at the physician prescriber-level Agreement and correlation between Xponent and Ontario Drug Benefit database, performance characteristics for Xponent to accurately identify high prescribing physicians The Xponent database has a specificity of 92.4% (95% CI 92.0–92.8%) and PPV of 77.2% (95% CI 76.0–78.4%) for correctly identifying the top 25th percentile of physicians by antibiotic volume. In the sensitivity analysis, 94% of the top 25th percentile physicians in Xponent were within the top 40th percentile in the reference database.…”
Section: Methodsmentioning
confidence: 99%
“…We measured the main primary and secondary outcomes at the prescriber level as 6 separate metrics: initiation, selection and duration of antibiotics, and initiation, selection and duration of opioids. Based on our previous validation study 11 and the proportion of estimated outlier prescribers in previous studies, [13][14][15] we considered physicians ranked in the top quartile of any of these metrics to be high prescribers for that particular metric.…”
Section: Discussionmentioning
confidence: 99%
“…An additional limitation is that there is no standard definition of “high prescriber.” We chose to use the top quartile in our study, as this has been previously measured and validated against other standard metrics of antibiotic use. 11 …”
Section: Discussionmentioning
confidence: 99%
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