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Antibiotic prescribing for pediatric respiratory infections: What explains a large variation among physicians?
Rachel McKay1, David M Patrick2, Kimberlyn McGrail3
1Postdoctoral fellow in the Department of Epidemiology, Biostatistics and Occupational Health at McGill University in Montreal, Que. rachel.mckay@mail.mcgill.ca.
Insights
Physician characteristics like experience and gender influence antibiotic prescribing for pediatric respiratory tract infections (RTIs). While some prescribing variations are explained, unexplained differences persist, suggesting a need for targeted interventions.
Area of Science:
- Pediatric infectious diseases
- Health services research
- Clinical pharmacology
Background:
- Antibiotic resistance is a growing global health concern.
- Inappropriate antibiotic prescribing for pediatric respiratory tract infections (RTIs) contributes to resistance.
- Understanding physician-level factors influencing prescribing is crucial for antimicrobial stewardship.
Purpose of the Study:
- To identify observable physician characteristics associated with antibiotic prescribing patterns for pediatric RTIs.
- To quantify the variation in antibiotic prescribing among physicians for pediatric RTIs.
- To explore the extent to which physician characteristics explain prescribing variations.
Main Methods:
- Population-based cohort study in British Columbia.
- Analysis of pediatric visits for RTIs between 2005 and 2011.
- Hierarchical generalized linear mixed-model analysis to assess associations between prescribing and patient, physician, and regional factors.
Main Results:
- Overall, 27.9% of pediatric RTI visits resulted in an antibiotic prescription.
- Significant variation in prescribing odds was observed across physicians, with a median 2-fold difference.
- Observable physician characteristics explained nearly half of the inter-physician prescribing variation. Factors associated with higher prescribing included more clinical experience, being an international medical graduate, and fewer recent RTI visits. Female physicians prescribed less frequently than male physicians.
Conclusions:
- Substantial and meaningful variation exists in antibiotic prescribing for pediatric RTIs among physicians.
- Observable physician characteristics account for a significant portion of this variation, but unexplained differences in prescribing propensity remain.
- Future interventions should target physicians with a higher propensity to prescribe, addressing behavioral aspects to improve antimicrobial stewardship.
Objective:
To explore whether there are observable physician characteristics associated with antibiotic prescribing for pediatric respiratory tract infections (RTIs).
Design:
Population-based cohort study using a hierarchical generalized linear mixed-model analysis.
Setting:
British Columbia.
Participants:
All pediatric visits for RTIs between 2005 and 2011.
Main Outcome Measures:
The association between an antibiotic prescription being dispensed within 5 days after each visit and patient, physician, and regional characteristics.
Results:
Overall, 27.9% of RTI visits were followed by an antibiotic prescription. After accounting for observed patient, physician, and regional factors, median 2-fold variation was found across physicians in their odds of prescribing. Observable physician characteristics explained nearly half of the variation between them. Higher prescribing was evident among physicians with more years of clinical experience (odds ratio [OR] of 1.46, 95% CI 1.33 to 1.61), international medical graduates (OR = 1.73, 95% CI 1.63 to 1.83), and physicians with proportionally fewer recent visits for RTIs (OR = 1.45, 95% CI 1.38 to 1.52). Female physicians prescribed less often than male physicians did (OR 0.91, 95% CI 0.86 to 0.96).
Conclusion:
Substantial variations were found among physicians in prescribing antibiotics for pediatric RTIs. Observable characteristics accounted for a meaningful proportion of this variation; however, some physicians have a higher propensity to prescribe than others do, which remains unexplained. Patient and regional characteristics did not explain much of the variation across physicians. In future, behavioural interventions should be designed and evaluated to target physicians with higher propensity to prescribe.
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