Medicare Part D Prescription Data May Improve Antibiotic Stewardship Programs

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In this study, researchers analyzed data on antibiotic prescriptions written for Medicare Part D beneficiaries to assess prescribing behaviors among clinicians in the United States.

A report from the US Department of Health and Human Services found that publicly available data may be leveraged for monitoring clinicians who prescribe an increased volume of antibiotics to optimize antibiotic stewardship interventions. These findings were published in the Morbidity and Mortality Weekly Report.

Data were sourced from the Centers for Medicare & Medicaid Services (CMS) Part D Prescriber Public Use Files. The majority of patients (~70%) enrolled in CMS Part D include those aged 65 years and older with either a disability or end-stage kidney disease. Clinicians who prescribed an increased volume (top 10%) of antibiotics in 2019 were assessed for their prescribing rate and patient populations.

The top 10% of prescribers comprised a total of 69,835 clinicians who dispensed 24.4 of the 59.4 million antibiotic prescriptions. These clinicians each wrote a median of 284 (IQR, 23-100) antibiotic prescriptions compared with 41 (IQR, 21-78) prescriptions among those considered to be lower-volume prescribers. The median total rate of antibiotic prescriptions among all clinicians in the high-volume group was increased by 60% compared with those in the low-volume group (680 vs 426 prescriptions per 1000 beneficiaries; P <.001).

Approximately half (48%) of US clinicians in the high-volume prescriber group practiced in the South. The rate of antibiotic prescriptions among these clinicians was increased when compared against clinicians who practiced in other US regions, with the greatest decreased rate observed among those who practiced in the Western United States (median, 649 prescriptions per 1000 beneficiaries; P <.001).

After stratification by specialty, the researchers found that 21% and 20% of those in the high-volume prescriber group included clinicians who specialized in family practice and internal medicine, respectively. These clinicians accounted for ~60% of all antibiotics prescribed within their specialties and ~22% of the total volume of antibiotic prescriptions.

The limitations of this study included that prescribing behaviors may not be uniform across patient populations, and the inability to assess prescribing behaviors among all US clinicians as only data on prescription claims to Medicare Part D were included in the analysis.

The researchers concluded, “this report demonstrates how publicly available data might be leveraged to monitor antibiotic use and identify higher-volume prescribers.” They also noted that “CMS Part D Prescribers by Provider data can be used by public health organizations and health care systems to guide antibiotic stewardship interventions and optimize antibiotic prescribing to limit the emergence of antibiotic resistance and improve patient outcomes.”

Reference

Gouin KA, Fleming-Dutra KE, Tsay S, Bizune D, Hicks LA, Kabbani S. Identifying higher-volume antibiotic outpatient prescribers using publicly available medicare part D data-United States, 2019. MMWR Morb Mortal Wkly Rep. 2022;71(6):202-205. doi:10.15585/mmwr.mm7106a3