Program Schedule

378
Comparing Antibiotic Prescribing Across Pediatric Ambulatory Settings

Session: Poster Abstract Session: Pediatric Antimicrobial Stewardship
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC

Comparing Antibiotic Prescribing Across Pediatric Ambulatory Settings

Background: While variability in antibiotic prescribing across primary care practices has been previously described, antibiotic prescribing has not been compared across alternate ambulatory sites, including urgent care and Emergency Department settings. Identifying site-specific practice patterns will help to tailor interventions to improve antibiotic prescribing.

Methods: Retrospective cohort study of all non-preventive encounters to a major pediatric Emergency Department (excluding encounters resulting in hospital admission) as well as 35 urban, suburban, and rural primary care and urgent care practices in 2013. Diagnosis codes, antibiotic orders, co-morbid medical conditions, antibiotic allergies, and demographic data were obtained from a comprehensive electronic health record. Center-specific antibiotic prescribing rates were calculated to assess variability and were adjusted for clustering by individual provider.

Results: An antibiotic prescription was given to 22% of 488,388 sick visits in 2013. After adjusting for patient age, sex, race, and insurance type and excluding encounters by patients with chronic conditions, rates of antibiotic prescribing by practice site ranged from 11% to 31% (Figure 1). The Emergency Department had the lowest rate of all ambulatory practices at 11%. (P<0.001 for all comparisons)

Conclusion: Significant variability in antibiotic prescribing occurs across all types of ambulatory pediatric care practices, and is unexplained by patient clinical or demographic factors. Identifying the predictors of and outcomes associated with these prescribing practices should help target interventions to improve patient care.

Figure 1. Variability of Antibiotic Prescribing Across Practice Sites

Carter Cowden, MPH, The Children's Hospital of Philadelphia, Philadelphia, PA, Elizabeth Alpern, MD, Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, Priya Prasad, MPH, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, Evanette Burrows, Children's Hospital of Philadelphia, Philadelphia, PA, Robert Grundmeier, MD, General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, A. Russell Localio, PhD, University of Pennsylvania School of Medicine, Philadelphia, PA and Jeffrey S. Gerber, MD, PhD, Department of Pediatrics, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA

Disclosures:

C. Cowden, None

E. Alpern, None

P. Prasad, None

E. Burrows, None

R. Grundmeier, None

A. R. Localio, None

J. S. Gerber, None

Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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