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Analysis of a high-prescribing state’s 2016 outpatient antibiotic prescriptions: Implications for outpatient antimicrobial stewardship interventions
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2 2020
Source: Infect Control Hosp Epidemiol. 41(2):135-142 -
Alternative Title:Infect Control Hosp Epidemiol
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Personal Author:
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Description: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.
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Subjects:
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Pubmed ID:31755401
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Pubmed Central ID:PMC7309961
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