Provider Variation in Antibiotic Prescribing and Outcomes of Respiratory Tract Infections
Mahesh Manne1, Abhishek Deshpande1, Bo Hu1
1From the Department of Internal Medicine, Medicine Institute, Cleveland Clinic, and the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
Objectives:
Inappropriate antibiotic use for respiratory tract infection (RTI) is an ongoing problem linked to the emergence of drug resistance and other adverse effects. Less is known about the prescribing practices of individual physicians or the impact of physician prescribing habits on patient outcomes. We studied the prescribing practices of providers for acute RTIs in an integrated health system, identified patient factors associated with receipt of an antibiotic and assessed the relation between providers' adjusted prescribing rates and a number of patient outcomes.
Methods:
This was a retrospective analysis of adults with an RTI visit to any primary care providers across the Cleveland Clinic Health System in 2011-2012. Patients with a history of chronic obstructive pulmonary disease or immunocompromised status were excluded. Logistic regression was used to examine patient factors associated with receipt of an antibiotic.
Results:
Of 31,416 patients with an RTI, 54.8% received an antibiotic. Patient factors associated with antibiotic prescribing included white race (odds ratio [OR] 1.35, P < 0.001), presence of fever (OR 1.66, P < 0.001), and a diagnosis of bronchitis (OR 10.98, P < 0.001) or sinusitis (OR 33.85, P < 0.001). Among 290 providers with ≥10 RTI visits, adjusted antibiotic prescribing rates ranged from 0% to 100% (mean 49%). Antibiotics were prescribed more often for sinusitis (OR 33.85, P < 0.001), bronchitis (OR 10.98, P < 0.001), or pharyngitis (OR 1.76, P < 0.001) compared with upper respiratory tract infection. Patients who were prescribed antibiotics at the index visit were more likely to return for RTI within 1 year (adjusted OR 1.26, P < 0.001). Emergency department visits for respiratory complications were rare and not associated with antibiotic receipt.
Conclusions:
Antibiotic prescribing for RTI varies widely among physicians and cannot be explained by patient factors. Patients prescribed antibiotics for RTI were more likely to return for RTI.
Insights
Physician antibiotic prescribing for respiratory infections varies widely and isn't explained by patient factors. Patients receiving antibiotics for respiratory tract infections (RTIs) were more likely to return for follow-up care.
Area of Science:
- Medical Research
- Infectious Diseases
- Health Services Research
Background:
- Inappropriate antibiotic use for respiratory tract infections (RTIs) contributes to antibiotic resistance and adverse effects.
- Understanding physician prescribing habits and their impact on patient outcomes is crucial.
Purpose of the Study:
- To investigate antibiotic prescribing practices for acute RTIs within an integrated health system.
- To identify patient factors influencing antibiotic receipt.
- To assess the relationship between physician prescribing rates and patient outcomes.
Main Methods:
- Retrospective analysis of adult RTI visits from 2011-2012 at Cleveland Clinic Health System.
- Exclusion of patients with COPD or immunocompromised status.
- Logistic regression to analyze patient factors associated with antibiotic prescribing.
Main Results:
- 54.8% of 31,416 RTI patients received antibiotics.
- Patient factors like white race, fever, bronchitis, and sinusitis were associated with antibiotic receipt.
- Physician prescribing rates varied widely (0-100%), with a mean of 49% among providers with ≥10 RTI visits.
- Antibiotics were prescribed more frequently for sinusitis, bronchitis, and pharyngitis compared to upper RTIs.
- Patients prescribed antibiotics were more likely to return for RTI within one year.
Conclusions:
- Significant variation exists in physician antibiotic prescribing for RTIs, not fully explained by patient characteristics.
- Physician prescribing habits may influence patient return rates for respiratory tract infections.
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