Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-30T21:33:05.854Z Has data issue: false hasContentIssue false
  • English
  • Français

Antibiotics for Respiratory Tract Infections: A Comparison of Prescribing in an Outpatient Setting

Published online by Cambridge University Press:  29 December 2014

Tamar F. Barlam ,
Jake R. Morgan ,
Lee M. Wetzler ,
Cindy L. Christiansen  and
Mari-Lynn Drainoni
Tamar F. Barlam*
Affiliation:
Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
Jake R. Morgan
Affiliation:
Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA
Lee M. Wetzler
Affiliation:
Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
Cindy L. Christiansen
Affiliation:
Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA
Mari-Lynn Drainoni
Affiliation:
Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Affairs Hospital, Bedford, MA, USA
*
Address correspondence to Tamar F. Barlam, MD, Boston Medical Center, Section of Infectious Diseases, 771 Albany Street, Dowling 3 North, Boston, Massachusetts USA 02118 ([email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

To examine inappropriate antibiotic prescribing for acute respiratory tract infections (RTIs) in ambulatory care to help target antimicrobial stewardship interventions.

Design and Setting

Retrospective analysis of RTI visits within general internal medicine (GIM) and family medicine (FM) ambulatory practices at an inner-city academic medical center from 2008 to 2010.

Methods

Patient, physician, and practice characteristics were analyzed using multivariable logistic regression to determine factors predictive of inappropriate prescribing; physicians in the highest and lowest antibiotic-prescribing quartiles were compared using χ2 analysis.

Results

Visits with FM providers, female gender, and self-reported race/ethnicity as white or Hispanic were significantly associated with inappropriate antibiotic prescribing. Physicians in the lowest quartile prescribed antibiotics for 5%–28% (mean, 21%) of RTI visits; physicians in the highest quartile prescribed antibiotics for 54%–85% (mean, 65%) of RTI visits. High prescribers had fewer African-American patients and more patients who were younger and privately insured. High prescribers had more patients with chronic lung disease. A GIM practice pod with a low prescriber was 3.0 times more likely to have a second low prescriber than other practice pods, whereas pods with a high prescriber were 1.3 times more likely to have a second high prescriber.

Conclusions

Medical specialty was the only physician factor predictive of inappropriate prescribing when patient gender, race, and comorbidities were taken into account. Possible disparities in care need further study. Stewardship education in medical school, enlisting low prescribers as physician leaders, and targeting interventions to the highest prescribers might be more effective approaches to antimicrobial stewardship.

Infect Control Hosp Epidemiol 2014;00(0): 1–7

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 2 , February 2015 , pp. 153 - 159
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Roumie, CL, Halasa, NB, Grijalva, CB, et al. Trends in antibiotic prescribing for adults in the United States—1995–2002. J Gen Intern Med 2005;20:697–702.Google Scholar
2. Grijalva, CG, Nuorti, JP, Grifiin, MR. Antibiotic prescription rates for acute respiratory tract infections in US ambulatory settings. JAMA 2009;302:758–766.Google Scholar
3. Snow, V, Mottur-Pilson, C, Gonzales, R. Principles of appropriate antibiotic use for treatment of nonspecific upper respiratory tract infections in adults. Ann Intern Med 2001;134:487–489.CrossRefGoogle ScholarPubMed
4. Barnett, ML, Linder, JA. Antibiotic prescribing to adults with sore throat in the United States, 1997–2010. JAMA Internal Med 2014;174:138–140.CrossRefGoogle ScholarPubMed
5. Office of Technology Assessment. Impacts of antibiotic-resistant bacteria (OTA-H-629). Washington, DC: US Government Printing Office, 1995.Google Scholar
6. Fridkin, SK, Steward, CD, Edwards, JR, et al. and Project ICARE. Surveillance of antimicrobial use and antimicrobial resistance in United States hospitals: Project ICARE Phase 2. Clin Infect Dis 1999;29:245–252.Google Scholar
7. Hicks, LA, Chien, YW, Taylor, TH Jr, Haber, M, Klugman, KP, ABC Team. Outpatient antibiotic prescribing and nonsusceptible Streptococcus pneumoniae in the United States, 1996–2003. Clin Infect Dis 2011;53:631–639.Google Scholar
8. Charani, E, Edwards, R, Sevdalis, N, et al. Behavior change strategies to influence antimicrobial prescribing in acute care: a systematic review. Clin Infect Dis 2011;53:651–662.Google Scholar
9. Davis, D, O’Brien, MA, Freemantle, N, Wolf, FM, Mazmanian, P, Taylor-Vaisey, A. Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or healthcare outcomes? JAMA 1999;282:867–874.Google Scholar
10. Agency for Healthcare Research and Quality (AHRQ). Closing the quality gap: a critical analysis of quality improvement strategies. 2006; Technical Review 9, Publication 04(06)-005104. Maryland AHRQ.Google Scholar
11. Smeets, HM, Kuyvenhoven, MM, Akkerman, AE, et al. Intervention with educational outreach at large scale to reduce antibiotics for respiratory tract infections: a controlled before and after study. Fam Pract 2009;26:183–187.Google Scholar
12. Butler, CC, Simpson, SA, Dunstan, F, et al. Effectiveness of multifaceted educational programme to reduce antibiotic dispensing in primary care: practice based randomised controlled trial. BMJ 2012;344:d8173.CrossRefGoogle ScholarPubMed
13. Wood, F, Simpson, S, Butler, CC. Socially responsible antibiotic choices in primary care: a qualitative study of GPs’ decisions to prescribe broad-spectrum and fluoroquinolone antibiotics. Fam Pract 2007;24:427–434.Google Scholar
14. Gonzales, R, Bartlett, JG, Besser, RE, et al. Principles of appropriate antibiotic use for treatment of acute respiratory tract infections in adults: background, specific aims, and methods. Ann Intern Med 2001;134:479–486.Google Scholar
15. Cantrell, R, Young, AF, Martin, BC. Antibiotic prescribing in ambulatory care settings for adults with colds, upper respiratory tract infections and bronchitis. Clin Ther 2002;24:170–182.CrossRefGoogle ScholarPubMed
16. Kroening-Roche, JC, Soroudi, A, Castillo, EM, Vilke, GM. Antibiotic and bronchodilator prescribing for acute bronchitis in the emergency department. J Emerg Med 2012;43:221–227.CrossRefGoogle ScholarPubMed
17. Grover, ML, Mookadam, M, Rutkowski, RH, et al. Acute respiratory tract infection: a practice examines its antibiotic prescribing habits. J Fam Pract 2012;61:330–335.Google ScholarPubMed
18. Williamson, HA Jr. A randomized, controlled trial of doxycycline in the treatment of acute bronchitis. J Fam Pract 1984;19:481–486.Google Scholar
19. Evans, AT, Husain, S, Durairaj, L, Sadowski, LS, Charles-Damte, M, Wang, Y. Azithromycin for acute bronchitis: a randomised, double-blind controlled trial. Lancet 2002;359:1648–1654.CrossRefGoogle ScholarPubMed
20. Fischer, T, Fischer, S, Kochen, MM, Hummers-Pradier, E. Influence of patient symptoms and physical findings on general practitioners’ treatment of respiratory tract infections: a direct observation study. BMC Fam Pract 2005;6:6.Google Scholar
21. Dosh, SA, Hickner, JM, Mainous, AG 3rd, Ebell, MH. Predictors of antibiotic prescribing for nonspecific upper respiratory tract infections, acute bronchitis, and acute sinusitis. A UPRNet Study. J Fam Pract 2000;49:407–414.Google ScholarPubMed
22. Wang, KY, Seed, P, Schofield, P, Ibrahim, S, Ashworth, M. Which practices are high antibiotic prescribers? A cross-sectional analysis. Br J Gen Pract 2009;59:e315–e320.Google Scholar
23. Aspinall, SL, Good, CB, Metlay, JP, Mor, MK, Fine, MJ. Antibiotic prescribing for presumed nonbacterial acute respiratory tract infections. Am J Emerg Med 2009;27:544–551.CrossRefGoogle ScholarPubMed
24. Cadieux, G, Tamblyn, R, Dauphinee, D, Libman, M. Predictors of inappropriate antibiotic prescribing among primary care physicians. CMAJ 2007;177:877–883.Google Scholar
25. Steinman, MA, Landefeld, CS, Gonzales, R. Predictors of broad-spectrum antibiotic prescribing for acute respiratory tract infections in adult primary care. JAMA 2003;289:719–725.CrossRefGoogle ScholarPubMed
26. Abbo, LM, Cosgrove, SE, Pottinger, PS, et al. Medical students’ perceptions and knowledge about antimicrobial stewardship: how are we educating our future prescribers? Clin Infect Dis 2013;57:631–638.Google Scholar
27. Sun, C, Jew, S, Dasta, SL. Osteopathic physicians in the United States: antibiotic prescribing practices for patients with nonspecific upper respiratory tract infections. J Am Osteopath Assoc 2006;106:450–455.Google Scholar
28. Gonzales, R, Steiner, JF, Sande, MA. Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. JAMA 1997;278:901–904.Google Scholar
29. Gerber, JS, Prasad, PA, Localio, AR, et al. Racial differences in antibiotic prescribing by primary care pediatricians. Pediatrics 2013;131:677–684.Google Scholar
30. Scott, JG, Cohen, D, DiCicco-Bloom, B, Orzano, AJ, Jaen, CR, Crabtree, BF. Antibiotic use in acute respiratory infections and the ways patients pressure physicians for a prescription. J Fam Pract 2001;50:853–858.Google Scholar
31. Coenen, S, Michiels, B, Renard, D, Denekens, J, Van Royen, P. Antibiotic prescribing for acute cough: the effect of perceived patient demand. Br J Gen Pract 2006;56:183–190.Google Scholar
32. Gulliford, M, Latinovic, R, Charlton, J, Little, P, van Staa, T, Ashworth, M. Selective decrease in consultations and antibiotic prescribing for acute respiratory tract infections in UK primary care up to 2006. J Public Health 2009;31:512–520.Google Scholar
33. McCaig, LF, Besser, RE, Hughes, JM. Trends in antimicrobial prescribing rates for children and adolescents. JAMA 2002;287:3096–3102.Google Scholar
34. Ashworth, M, Charlton, J, Ballard, K, Latinovic, R, Gulliford, M. Variations in antibiotic prescribing and consultation rates for acute respiratory infection in UK general practices 1995–2000. Br J Gen Pract 2005;55:603–608.Google Scholar
35. Doyne, EO, Alfaro, MP, Siegel, RM, et al. A randomized controlled trial to change antibiotic prescribing patterns in a community. Arch Pediatr Adolesc Med 2004;158:577–583.Google Scholar
36. Maselli, JH, Gonzales, R. Colorado medical Society Joint Data Project Investigators. Measuring antibiotic prescribing practices among ambulatory physicians: accuracy of administrative claims data. J Clin Epidemiol 2001;54:196–201.CrossRefGoogle ScholarPubMed