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Informing antimicrobial stewardship: factors associated with inappropriate antimicrobial prescribing in primary care
Alexander Singer1, Sergio Fanella2, Leanne Kosowan1
1Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Background:
Antimicrobial stewardship (AS) programs promote the optimal use of antimicrobials and safe patient care. With most antimicrobials prescribed in the ambulatory setting, establishing benchmark data is imperative to gauge the impact of future AS initiatives.
Objectives:
To determine the frequency of potentially inappropriate antimicrobial prescribing in primary care practices in Manitoba, Canada and to assess the association between potentially inappropriate antimicrobial prescribing and patient, prescriber and practice-related factors.
Methods:
A retrospective cohort study using the Manitoba Primary Care Research Network repository of de-identified Electronic Medical Records from consenting primary care practices. Descriptive statistics and logistic regressions detailed patients with bacterial or viral infections of interest and antimicrobial prescriptions.
Results:
Eighteen percent (n = 35 574) of primary care visits for common infections were associated with a potentially inappropriate antimicrobial prescription. Among antimicrobials prescribed to patients diagnosed with bacterial infections, 37.8% (n = 2168) had a potentially inappropriate antimicrobial prescribed and 19.6% (n = 1126) had an antimicrobial prescribed for a duration outside of guideline-based ranges. Female patients, younger age and less office visits were associated with potentially inappropriate antimicrobial prescribing for bacterial infections. Among physician visits for viral infection, 15.9% (n = 29 833) were associated with an antimicrobial prescription. Older patients, those with more comorbidity, more office visits and those who were seen in larger or rural practices, were associated with potentially inappropriate antimicrobial prescribing for viral infections.
Conclusions:
High frequency of potentially inappropriate antimicrobial prescribing, especially in certain patient populations, suggests the need for coordinated community-based AS programs to optimize prescribing and improve patient care.
Insights
Potentially inappropriate antimicrobial prescribing is common in primary care for both bacterial and viral infections. This highlights the need for community-based antimicrobial stewardship (AS) programs to improve patient care.
Area of Science:
- Infectious Diseases
- Public Health
- Health Services Research
Background:
- Antimicrobial stewardship (AS) programs are crucial for optimizing antimicrobial use and ensuring patient safety.
- The majority of antimicrobial prescriptions occur in outpatient settings, making benchmark data essential for evaluating AS initiatives.
Purpose of the Study:
- To quantify the incidence of potentially inappropriate antimicrobial prescribing in Canadian primary care practices.
- To identify patient, prescriber, and practice-related factors associated with inappropriate antimicrobial prescribing.
Main Methods:
- A retrospective cohort study utilized de-identified Electronic Medical Records from the Manitoba Primary Care Research Network.
- Descriptive statistics and logistic regression analyses were performed on data concerning common infections and antimicrobial prescriptions.
Main Results:
- Eighteen percent of primary care visits for common infections involved potentially inappropriate antimicrobial prescriptions.
- Inappropriate prescribing was linked to patient demographics (female, younger age) and visit characteristics for bacterial infections.
- Factors such as older age, comorbidities, and practice setting were associated with inappropriate prescribing for viral infections.
Conclusions:
- A high rate of potentially inappropriate antimicrobial prescribing necessitates community-based AS programs.
- Optimizing antimicrobial use in primary care is vital for improving patient outcomes and combating antimicrobial resistance.
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