Antimicrobial stewardship is essential in order to minimize unnecessary antibiotic use and curb the emergence of drug resistant pathogens. However, national trends in antibiotic prescribing have been discouraging, particularly in the outpatient setting. The purpose of this study is to characterize outpatient antibiotic prescribing practices within a large academic healthcare network and to identify factors associated with inappropriate prescribing.
This was a retrospective study of primary care visits in 2014 within the University of Pennsylvania Health System. Patient de-identified data including antibiotic prescriptions and diagnoses were extracted from the medical record system. Visit diagnoses were classified into three tiers, with Tier 1 diagnoses defined as those almost always requiring antibiotics, Tier 2 only sometimes requiring antibiotics, and Tier 3 practically never requiring antibiotics. Logistic regression was used to determine association of prescribing antibiotics for tier 3 diagnoses with provider specialty, years of certification and type of practice.
A total of 424,207 visits were studied among 188 providers. The median rates of prescribing antibiotics for Tier 1, 2 and 3 visits were 33.3%, 34.2% and 15.1% respectively. There was considerable inter-provider variability in Tier 3 prescribing rates, with the top quartile prescribing antibiotics for 22.1% to 54.2% of Tier 3 visits versus the bottom quartile prescribing for 3.5% to 10.1% of Tier 3 visits. Providers in the top quartile were more likely to be nurse practitioners (OR 15.89 [CI 5.03-50.12]; p<0.001) or physician assistants (OR 31.20 [CI 3.72 – 261.48]; p<0.002) as compared to medical doctors. They were also more likely to be trained in family medicine as compared to internal medicine (OR 7.03 [CI 2.45-10.12]; p<0.001) and to work at a clinical site without medical trainees (OR 4.48 [CI 1.37 – 14.67]; p<0.013).
There was considerable variability in outpatient antibiotic prescribing practices among providers in a large academic healthcare network. Understanding characteristics of clinicians that prescribe antibiotics for inappropriate conditions may help to target stewardship interventions.
J. M. Mehta, Teqqa, LLC: Employee , Salary
K. Degnan, None
K. Hamilton, None