Antibiotic Prescribing by Physicians Versus Nurse Practitioners for Pediatric Upper Respiratory Infections
Elisabeth H Ference1, Jin-Young Min2, Rakesh K Chandra3
1Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA Elisabeth.h.ference@gmail.com.
Insights
Nurse practitioners (NPs) prescribe antibiotics more often than physicians for pediatric upper respiratory infections (URIs). This difference narrows when accounting for practice specialty, highlighting the need for evidence-based prescribing guidelines.
Area of Science:
- Pediatric Medicine
- Health Services Research
- Pharmacology
Background:
- Antibiotic prescribing rates for pediatric upper respiratory infections (URIs) vary.
- Differences in prescribing patterns between physicians and nurse practitioners (NPs) are not fully understood.
Purpose of the Study:
- To investigate and compare antibiotic prescribing rates for pediatric URIs between physicians and NPs.
- To identify factors influencing these prescribing differences.
Main Methods:
- Analysis of data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Care Survey (2001-2010).
- Inclusion of children under 18 diagnosed with URI.
- Logistic regression models to examine antibiotic prescribing variations between physicians and NPs, adjusting for patient and practice characteristics.
Main Results:
- Nurse practitioners (NPs) prescribed antibiotics in 66.7% of pediatric URI visits, compared to 52.8% for physicians (unadjusted).
- After adjustment for specialty, URI type, and chronic diseases, NPs showed marginally significantly higher odds of prescribing antibiotics (OR=1.6, P=0.048).
- Prescribing rates for NPs for otitis media decreased from 2001-2002 to 2009-2010.
Conclusions:
- Nurse practitioners (NPs) exhibit higher antibiotic prescribing rates for pediatric URIs than physicians.
- The disparity in prescribing is reduced when considering practice specialty.
- Comparative analysis of antibiotic prescribing is crucial for promoting evidence-based practice and guideline adherence.
Background:
This study investigates differences in antibiotic prescribing rates for pediatric upper respiratory infections (URIs) between physicians and nurse practitioners (NPs).
Methods:
Visits by children <18 years old diagnosed with URI to physicians or NPs between 2001 and 2010 were abstracted from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Care Survey. Logistic regression analyses examined variations in antibiotic prescribing rates.
Results:
Upper respiratory infections accounted for approximately 439 ± 21.5 million visits. Patients seen by NPs were more likely to have Medicaid, live in the lowest median household income quartile zip codes and micropolitan locations, and live in the South compared to patients seen by physicians. Nurse practitioners prescribed antibiotics 66.7% ± 4.2% of the time versus physicians at 52.8% ± 0.8% for URI visits (unadjusted P-value = .002). Adjusted by specialty, URI type, and chronic diseases, NPs had marginally significantly different odds of prescribing antibiotics (OR = 1.6, 95% CI, 1.0-2.6, P-value = .048), but the association with prescribing broad-spectrum antibiotics is not as strong (adjusted P-value = .063). Patient visits to a pediatric (OR = 0.54, 95% CI, 0.43-0.67) or ENT/surgery practice (OR = 0.11, 95% CI, 0.06-0.18) had lower odds of antibiotic prescribing compared to general/family medicine practices. Year (2001-2010) was not significantly associated with antibiotic or broad-spectrum antibiotic prescribing rates for physicians, but rates for NPs fell for otitis media (P-value = .007) from 90.2% ± 8.2% (2001-2002) to 74.8% ± 6.8% (2009-2010) of visits.
Conclusions:
Nurse practitioners have higher rates of antibiotic prescribing compared to physicians for pediatric patients with URIs; however, this difference is less after adjusting for specialty. Examining comparative antibiotic prescribing is important to promote evidence-based practice and adoption of clinical guidelines.
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