Antibiotic Prescribing for Nonbacterial Acute Upper Respiratory Infections in Elderly Persons
Michael Silverman1, Marcus Povitz1, Jessica M Sontrop1
1From Schulich School of Medicine and Dentistry, St. Joseph's Health Care; the Institute for Clinical Evaluative Sciences at Western; Victoria Hospital; and Byron Family Medical Centre, London, Ontario, Canada.
Background:
Reducing inappropriate antibiotic prescribing for acute upper respiratory tract infections (AURIs) requires a better understanding of the factors associated with this practice.
Objective:
To determine the prevalence of antibiotic prescribing for nonbacterial AURIs and whether prescribing rates varied by physician characteristics.
Design:
Retrospective analysis of linked administrative health care data.
Setting:
Primary care physician practices in Ontario, Canada (January-December 2012).
Patients:
Patients aged 66 years or older with nonbacterial AURIs. Patients with cancer or immunosuppressive conditions and residents of long-term care homes were excluded.
Measurements:
Antibiotic prescriptions for physician-diagnosed AURIs. A multivariable logistic regression model with generalized estimating equations was used to examine whether prescribing rates varied by physician characteristics, accounting for clustering of patients among physicians and adjusting for patient-level covariates.
Results:
The cohort included 8990 primary care physicians and 185 014 patients who presented with a nonbacterial AURI, including the common cold (53.4%), acute bronchitis (31.3%), acute sinusitis (13.6%), or acute laryngitis (1.6%). Forty-six percent of patients received an antibiotic prescription; most prescriptions were for broad-spectrum agents (69.9% [95% CI, 69.6% to 70.2%]). Patients were more likely to receive prescriptions from mid- and late-career physicians than early-career physicians (rate difference, 5.1 percentage points [CI, 3.9 to 6.4 percentage points] and 4.6 percentage points [CI, 3.3 to 5.8 percentage points], respectively), from physicians trained outside of Canada or the United States (3.6 percentage points [CI, 2.5 to 4.6 percentage points]), and from physicians who saw 25 to 44 patients per day or 45 or more patients per day than those who saw fewer than 25 patients per day (3.1 percentage points [CI, 2.1 to 4.0 percentage points] and 4.1 percentage points [CI, 2.7 to 5.5 percentage points], respectively).
Limitation:
Physician rationale for prescribing was unknown.
Conclusion:
In this low-risk elderly cohort, 46% of patients with a nonbacterial AURI were prescribed antibiotics. Patients were more likely to receive prescriptions from mid- or late-career physicians with high patient volumes and from physicians who were trained outside of Canada or the United States.
Primary Funding Source:
Ontario Ministry of Health and Long-term Care, Academic Medical Organization of Southwestern Ontario, Schulich School of Medicine and Dentistry, Western University, and Lawson Health Research Institute.
Insights
Nearly half of elderly patients with nonbacterial upper respiratory tract infections (AURIs) received antibiotic prescriptions. Mid- or late-career physicians with high patient volumes and those trained internationally were more likely to prescribe antibiotics.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Health Services Research
Background:
- Reducing inappropriate antibiotic prescribing for acute upper respiratory tract infections (AURIs) is crucial.
- Understanding factors influencing antibiotic prescribing practices is necessary.
Purpose of the Study:
- To determine the prevalence of antibiotic prescribing for nonbacterial AURIs in elderly patients.
- To investigate if antibiotic prescribing rates varied by physician characteristics.
Main Methods:
- Retrospective analysis of linked administrative health care data in Ontario, Canada (2012).
- Included patients aged 66+ with nonbacterial AURIs, excluding those with cancer, immunosuppression, or in long-term care.
- Used multivariable logistic regression to analyze prescribing variations by physician characteristics.
Main Results:
- 46% of 185,014 patients with nonbacterial AURIs received antibiotic prescriptions, predominantly broad-spectrum agents.
- Prescribing rates were higher for mid- and late-career physicians compared to early-career physicians.
- Physicians trained outside Canada/US and those with higher patient volumes (25+ patients/day) showed increased prescribing rates.
Conclusions:
- A significant proportion of elderly patients with nonbacterial AURIs received antibiotic prescriptions.
- Physician career stage, patient volume, and international training were associated with higher prescribing rates.
- The rationale behind physician prescribing decisions remains unknown.
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