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Analysis of a high-prescribing state’s 2016 outpatient antibiotic prescriptions: Implications for outpatient antimicrobial stewardship interventions

Published online by Cambridge University Press:  22 November 2019

Milner B. Staub Open the ORCID record for Milner B. Staub [Opens in a new window] ,
Youssoufou Ouedraogo ,
Christopher D. Evans ,
Sophie E. Katz ,
Pamela P. Talley ,
Marion A. Kainer  and
George E. Nelson
Milner B. Staub*
Affiliation:
Veterans Health Administration, Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
Youssoufou Ouedraogo
Affiliation:
Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Health, Nashville, Tennessee
Christopher D. Evans
Affiliation:
Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Health, Nashville, Tennessee
Sophie E. Katz
Affiliation:
Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
Pamela P. Talley
Affiliation:
Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Health, Nashville, Tennessee
Marion A. Kainer
Affiliation:
Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Health, Nashville, Tennessee
George E. Nelson
Affiliation:
Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
*
Author for correspondence: Milner Staub, Email: [email protected]
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Abstract

Objective:

To identify prescriber characteristics that predict antibiotic high-prescribing behavior to inform statewide antimicrobial stewardship interventions.

Design:

Retrospective analysis of 2016 IQVIA Xponent, formerly QuintilesIMS, outpatient retail pharmacy oral antibiotic prescriptions in Tennessee.

Setting:

Statewide retail pharmacies filling outpatient antibiotic prescriptions.

Participants:

Prescribers who wrote at least 1 antibiotic prescription filled at a retail pharmacy in Tennessee in 2016.

Methods:

Multivariable logistic regression, including prescriber gender, birth decade, specialty, and practice location, and patient gender and age group, to determine the association with high prescribing.

Results:

In 2016, 7,949,816 outpatient oral antibiotic prescriptions were filled in Tennessee: 1,195 prescriptions per 1,000 total population. Moreover, 50% of Tennessee’s outpatient oral antibiotic prescriptions were written by 9.3% of prescribers. Specific specialties and prescriber types were associated with high prescribing: urology (odds ratio [OR], 3.249; 95% confidence interval [CI], 3.208–3.289), nurse practitioners (OR, 2.675; 95% CI, 2.658–2.692), dermatologists (OR, 2.396; 95% CI, 2.365–2.428), physician assistants (OR, 2.382; 95% CI, 2.364–2.400), and pediatric physicians (OR, 2.340; 95% CI, 2.320–2.361). Prescribers born in the 1960s were most likely to be high prescribers (OR, 2.574; 95% CI, 2.532–2.618). Prescribers in rural areas were more likely than prescribers in all other practice locations to be high prescribers. High prescribers were more likely to prescribe broader-spectrum antibiotics (P < .001).

Conclusions:

Targeting high prescribers, independent of specialty, degree, practice location, age, or gender, may be the best strategy for implementing cost-conscious, effective outpatient antimicrobial stewardship interventions. More information about high prescribers, such as patient volumes, clinical scope, and specific barriers to intervention, is needed.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 2 , February 2020 , pp. 135 - 142
Creative Commons
This work is classified, for copyright purposes, as a work of the U.S. Government and is not subject to copyright protection within the United States.
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.

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Footnotes

PREVIOUS PRESENTATION: These data were presented at the Society for Healthcare Epidemiology of America Spring Meeting in an oral abstract on April 26, 2019, in Boston, Massachusetts.

References

Patient Safety Atlas. Centers for Disease Control and Prevention website. https://gis.cdc.gov/grasp/PSA/index.html. Published 2019. Accessed July 5, 2019.Google Scholar
Hicks, LA, Bartoces, MG, Roberts, RM, et al.US outpatient antibiotic prescribing variation according to geography, patient population, and provider specialty in 2011. Clin Infect Dis 2015;60:1308–1316.Google ScholarPubMed
King, LM, Bartoces, M, Fleming-Dutra, KE, Roberts, RM, Hicks, LA. Changes in US outpatient antibiotic prescriptions from 2011–2016. Clin Infect Dis 2019. doi: 10.1093/cid/ciz225.CrossRefGoogle Scholar
National action plan for combating antibiotic-resistant bacteria, 2015. The White House website. https://obamawhitehouse.archives.gov/sites/default/files/docs/national_action_plan_for_combating_antibotic-resistant_bacteria.pdf. Published 2015. Accessed July 5, 2019.Google Scholar
Fleming-Dutra, KE, Hersh, AL, Shapiro, DJ, et al.Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010–2011. JAMA 2016;315:1864–1873.CrossRefGoogle ScholarPubMed
Havers, FP, Hicks, LA, Chung, JR, et al.Outpatient antibiotic prescribing for acute respiratory infections during influenza seasons. JAMA Netw Open 2018;1:e180243.CrossRefGoogle ScholarPubMed
Palms, DL, Hicks, LA, Bartoces, M.Comparison of antibiotic prescribing in retail clinics, urgent care centers, emergency departments, and traditional ambulatory care settings in the United States. JAMA Intern Med 2018;178:1267–1269.CrossRefGoogle ScholarPubMed
Chua, KP, Fischer, MA, Linder, JA.Appropriateness of outpatient antibiotic prescribing among privately insured US patient: ICD-10-CM based cross sectional study. BMJ 2019;364:K5092.CrossRefGoogle ScholarPubMed
Fleming-Dutra, KE, Bartoces, M, Roberts, RM, Hicks, LA.Characteristics of primary care physicians associated with high outpatient antibiotic prescribing volume. Open Forum Infect Dis 2018;5:ofx279.CrossRefGoogle ScholarPubMed
Cadieux, G, Tamblyn, R, Dauphinee, D, Libman, M.Predictors of inappropriate antibiotic prescribing among primary care physicians. CMAJ 2007;177:877–883.CrossRefGoogle ScholarPubMed
Stone, S, Gonzales, R, Maselli, J, Lowenstein, SR.Antibiotic prescribing for patients with colds, upper respiratory tract infections and bronchitis: a national study of hospital-based emergency departments. Ann Emerg Med 2000;36:320–327.CrossRefGoogle ScholarPubMed
Boardman, C, inventor; IMS Health Incorporated, assignee. System and method for estimating product distribution using a product specific universe. US patent 7,174,304. February 6, 2007.Google Scholar
Population counts by age group, sex, race and ethnicity, estimates 2016. Tennessee Department of Health, Division of Policy, Planning and Assessment website. https://www.tn.gov/content/dam/tn/health/documents/TN_Population_by_Agegrp_Sex_Race_Ethnicity_-_2016.pdf. Published 2016. Accessed September 2018.Google Scholar
Ingram, DD, Franco, SJ. 2013 NCHS Urban–rural classification scheme for counties. Vital Health Stat 2, pp. 1–73. Centers for Disease Control and Prevention website. http://www.cdc.gov/nchs/data/series/sr_02/sr02_166.pdf. Published 2014. Accessed September 2018.Google Scholar
Suda, KJ, Hicks, LA, Roberts, RM, Hunkler, RJ, Matusiak, LM, Schumock, GT.Antibiotic expenditures by medication, class, and healthcare setting in the United States, 2010–2015. Clin Infect Dis 2018;66:185–190.CrossRefGoogle ScholarPubMed
Antimicrobial stewardship in ambulatory health care. R3 Report. The Joint Commission website. https://www.jointcommission.org/assets/1/18/R3_23_Antimicrobial_Stewardship_AMB_6_14_19_FINAL2.pdf. Published 2019. Accessed July 5, 2019.Google Scholar
Aabenhus, R, Siersma, V, Sandholdt, H, Køster-Rasmussen, R, Hansen, MP, Bjerrum, L.Identifying practice-related factors for high-volume prescribers of antibiotics in Danish general practice. J Antimicrob Chemother 2017;72:2385–2391.CrossRefGoogle ScholarPubMed
Lebentrau, S, Gilfrich, C, Vetterlein, MW, Schumacher, H, et. al.Impact of the medical specialty on knowledge regarding multidrug-resistant organisms and strategies toward antimicrobial stewardship. Int Urol Nephrol 2017;49:1311–1318.CrossRefGoogle ScholarPubMed
Barlam, TF, Morgan, JR, Wetzler, LM, Christiansen, CL, Drainoni, ML.Antibiotics for respiratory tract infections: a comparison of prescribing in an outpatient setting. Infect Control Hosp Epidemiol 2015;36:153–159.CrossRefGoogle Scholar
Finkelstein, JA, Stille, C, Nordin, J, et al.Reduction in antibiotic use among US children, 1996–2000. Pediatrics 2003;112:620–627.CrossRefGoogle Scholar
McCaig, LF, Hicks, LA, Roberts, RM, Fairlie, TA.Office-related antibiotic prescribing for persons aged ≤14 years—United States, 1993–1994 to 2007–2008. Morb Mortal Wkly Rep 2011;60:1153–1156.Google Scholar
Roberts, RM, Bartoces, M, Thompson, SE, Hicks, LA.Antibiotic prescribing by general dentists in the United States, 2013. J Am Dent Assoc 2017;148:172–8.e1.CrossRefGoogle ScholarPubMed
Durkin, MJ, Hsueh, K, Sallah, YH, et. al.An evaluation of dental antibiotic prescribing practices in the United States. J Am Dent Assoc 2017;148:878–86.e1.CrossRefGoogle ScholarPubMed
Blommaert, A, Coenen, S, Gielen, B, Goossens, H, Hens, N, Beutels, P.Patient and prescriber determinants for the choice between amoxicillin and broader-spectrum antibiotics: a nationwide prescription-level analysis. J Antimicrob Chemother 2013;86:2383–2392.CrossRefGoogle Scholar
Arnold, SR, Straus, SE.Interventions to improve antibiotic prescribing practices in ambulatory care. Cochrane Database Syst Rev 2005;4:CD003539.Google Scholar