Methods: At a single VA medical center, patient visits during 2016 to primary care or the emergency department (ED) were retrospectively reviewed if associated with an ICD-10 code for cystitis or an ARTI. Using manual chart-review, an over-treatment rate was calculated for each provider by determining the frequency at which antimicrobials were prescribed when not indicated. A volume-adjusted antimicrobial prescribing rate was determined by extracting data on all antimicrobials prescribed by each provider and adjusting for the total number of patient-visits for that provider.
Results: Manual audits to determine antimicrobial necessity were performed on 633 ED visits and 247 primary-care visits. Antimicrobials were not indicated in 51% (324) of ED visits and 58% (144) of primary care visits. For 14 ED providers, the median antimicrobial-prescribing volume was 13.7 prescriptions per 100 patient-visits (IQR 12.5-14.8), and the median over-treatment rate was 47% (IQR 28-64%). Among 7 primary care providers, the median volume-adjusted antimicrobial prescribing rate was 8.1 prescriptions per 100 patient-visits (IQR 7.3-8.6), and the median over-treatment rate was 33% (IQR 31-59%).
There was a positive correlation between a provider’s volume-adjusted antimicrobial prescribing rate and their overall rate of over-treatment in both the ED (r=0.67, p<0.01) and primary care (r=0.80, p=0.03).
Conclusion: In this small study, electronically-extracted data on a provider’s rate of volume-adjusted antimicrobial prescribing strongly correlated with the frequency at which unnecessary antimicrobials were prescribed, particularly in primary care. Comparing providers within a given outpatient setting on their volume-adjusted antimicrobial prescribing rate may be an efficient way to identify over-prescribers.
B. Alexander, None
B. Heintz, None
T. Tubbs, None
E. Perencevich, None