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Phantom Prescribing: Examining the Frequency of Antimicrobial Prescriptions Without a Patient Visit
Benjamin N Riedle1, Linnea A Polgreen2, Joseph E Cavanaugh1
11Department of Biostatistics,University of Iowa,Iowa City,Iowa.
Abstract:
OBJECTIVE To investigate the scale of antimicrobial prescribing without a corresponding visit, and to compare the attributes of patients who received antimicrobials with a corresponding visit with those who did not have a visit. DESIGN Retrospective cohort. METHODS We followed up 185,010 Medicare patients for 1 year after an acute myocardial infarction. For each antimicrobial prescribed, we determined whether the patient had an inpatient, outpatient, or provider claim in the 7 days prior to the antimicrobial prescription being filled. We compared the proportions of patient characteristics for those prescriptions associated with a visit and without a visit (ie, phantom prescriptions). We also compared the rates at which different antimicrobials were prescribed without a visit. RESULTS We found that of 356,545 antimicrobial prescriptions, 14.75% had no evidence of a visit in the week prior to the prescription being filled. A higher percentage of patients without a visit were identified as white (P<.001) and female (P<.001). Patients without a visit had a higher likelihood of survival and fewer additional cardiac events (acute myocardial infarction, cardiac arrest, stroke, all P<.001). Among the antimicrobials considered, amoxicillin, penicillin, and agents containing trimethoprim and methenamine were much more likely to be prescribed without a visit. In contrast, levofloxacin, metronidazole, moxifloxacin, vancomycin, and cefdinir were much less likely to be prescribed without a visit. CONCLUSIONS Among this cohort of patients with chronic conditions, phantom prescriptions of antimicrobials are relatively common and occurred more frequently among those patients who were relatively healthy. Infect Control Hosp Epidemiol 2017;38:273-280.
Insights
Antimicrobial prescriptions without a corresponding patient visit, termed "phantom prescriptions," are common in patients with chronic conditions. These prescriptions were more frequent in healthier patients and associated with better survival rates.
Area of Science:
- Clinical Pharmacy
- Health Services Research
- Epidemiology
Background:
- Antimicrobial stewardship is crucial for combating resistance and optimizing patient care.
- Understanding prescribing patterns, especially those lacking direct patient interaction, is essential for improving medication safety.
Purpose of the Study:
- To quantify the incidence of antimicrobial prescriptions issued without an associated patient visit (phantom prescriptions).
- To compare patient characteristics between those receiving antimicrobials with and without a documented visit.
- To identify specific antimicrobial agents more or less likely to be prescribed as phantom prescriptions.
Main Methods:
- A retrospective cohort study analyzed 356,545 antimicrobial prescriptions for 185,010 Medicare patients post-myocardial infarction over one year.
- Prescriptions were categorized based on the presence or absence of an inpatient, outpatient, or provider claim within seven days prior to dispensing.
- Patient demographics and clinical outcomes were compared between the 'visit' and 'no visit' (phantom prescription) groups.
Main Results:
- 14.75% of antimicrobial prescriptions lacked evidence of a preceding patient visit.
- Patients receiving phantom prescriptions were more likely to be white, female, and had better survival rates with fewer cardiac events.
- Amoxicillin, penicillin, trimethoprim, and methenamine agents were frequently prescribed without a visit, while levofloxacin, metronidazole, moxifloxacin, vancomycin, and cefdinir were less common.
Conclusions:
- Phantom antimicrobial prescribing is a significant issue in patients with chronic conditions.
- This practice appears more prevalent in healthier patient subsets and is paradoxically linked to improved survival.
- Further investigation is needed to understand the clinical implications and potential risks associated with phantom antimicrobial prescriptions.
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