Research published in Infection Control & Hospital Epidemiology concluded that a combination of patient, practice, and provider characteristics are associated with improper antimicrobial prescribing.
Data from outpatient visits for common respiratory conditions that should not require antimicrobials (acute bronchitis, bronchiolitis, nonsuppurative otitis media, or viral upper respiratory infection) were collected between January 2014 and May 2016 from the Carolinas HealthCare System to investigate factors associated with inappropriate antibiotic prescriptions.
In total 448,990 visits — involving 281,315 unique patients to urgent care, family medicine, internal medicine, and pediatric practices — were included in the cohort and only oral prescriptions written at outpatient visits were included in the study data.
Overall prescribing rates for both adult and pediatric patients were 407 per 1000 visits (95% CI, 405-408). Of the 4 conditions, acute bronchitis had the highest rate of inappropriate prescription at 703 per 1000 visits (95% CI, 700-706), according to unadjusted analysis. Adjusted analysis indicated that adult patients seen by an advanced practice clinician had a 15% greater chance of receiving a prescription compared with those seeing a physician provider (incident risk ratio [IRR], 1.15; 95% CI, 1.03-1.29). For pediatric visits, older providers (between 51 and 60 years of age) were 4 times more likely to prescribe antimicrobials compared with providers ≤30 years (IRR, 4.21; 95% CI, 2.96-5.97).
The study design assumed that when antibiotics were prescribed, they were intended for the treatment 1 of the 4 conditions indicated and not for some other purpose. The results identify acute bronchitis as a diagnosis resulting in frequent antibiotic misuse. Further, it was concluded that antibiotic misuse was associated with multiple factors; therefore, a “one-size-fits-all” approach to stewardship may not be effective for addressing this clinical challenge.
Schmidt ML, Spencer MD, Davidson LE. Patient, provider, and practice characteristics associated with inappropriate antimicrobial prescribing in ambulatory practices [published online January 20, 2018]. Infect Control Hosp Epidemiol. doi: 10.1017/ice.2017.263