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Published on: August 30, 2018
Exploring the Association Between Antibiotic Prescribing Patterns and Clinical Variations in a Network of
Jordan A Nelson1, Patrick K Hunter2
1Pediatrics, University of Central Florida College of Medicine, Orlando, USA.
Introduction:
Variation in practice patterns among physicians is well-documented despite professional guidelines and increasingly uniform medical training. Variations may lead to improper utilization of healthcare resources, misdiagnosis, overdiagnosis, unnecessary treatments, and forgoing of needed interventions. One area of clinical variation and overuse of particular interest is the prescribing of antibiotics, which can lead to eventual antibiotic resistance and other negative consequences. Variations in antibiotic prescribing along with other practice patterns have been studied previously but no attempt has been made to examine the correlation between multiple practice patterns. The purpose of this study was to determine if a correlation existed between the provider behaviors studied.
Methods:
A small area network of 39 pediatric providers was analyzed to determine if antibiotic prescription percentages varied. Antibiotic prescription percentages were further broken down by visit type (sick versus well). Two other practice measures, in-office lab utilization and diagnoses of food and drug allergies, were then analyzed. Data were explored primarily with Spearman's correlation tests.
Results:
Strong positive correlation was seen between a provider's antibiotic prescription percentage at sick and well visits. Strong positive correlation was seen between the antibiotic prescribing percentage and the number of in-office labs ordered. Moderate positive correlation was seen between antibiotic prescribing percentage and the percentage of a provider's empaneled patients with any allergy diagnosis (medication, food, or seasonal).
Conclusion:
This retrospective study demonstrates that variation in provider practice patterns continues to exist despite established practice guidelines from national organizations. It also demonstrates a linear correlation between multiple provider behaviors that have not previously been explored together. The presence of a correlation between clinical behaviors may suggest an underlying practice philosophy and present an opportunity for personalized, provider-specific education and quality improvement.
Insights
Physician practice patterns vary, with antibiotic prescribing correlating with in-office lab use and allergy diagnoses. This suggests a common practice philosophy, offering opportunities for targeted quality improvement initiatives.
Area of Science:
- Pediatric Practice Patterns
- Healthcare Quality Improvement
- Antibiotic Stewardship
Background:
- Physician practice variations persist despite guidelines, potentially leading to resource misuse and suboptimal patient outcomes.
- Antibiotic prescribing variations are a significant concern due to the rise of antibiotic resistance.
- Previous studies examined practice variations individually; this research explores correlations between multiple provider behaviors.
Purpose of the Study:
- To investigate correlations between different provider practice patterns, including antibiotic prescribing, in-office lab utilization, and allergy diagnoses.
- To determine if a relationship exists between a provider's antibiotic prescription rates and other clinical behaviors.
Main Methods:
- Retrospective analysis of data from 39 pediatric providers.
- Examination of antibiotic prescription percentages, stratified by visit type (sick vs. well).
- Analysis of in-office laboratory utilization and the proportion of patients with allergy diagnoses.
- Statistical analysis primarily using Spearman's correlation tests.
Main Results:
- A strong positive correlation was observed between antibiotic prescription percentages for sick and well visits.
- Significant positive correlation found between antibiotic prescribing rates and the number of in-office laboratory tests ordered.
- Moderate positive correlation identified between antibiotic prescribing percentage and the prevalence of any allergy diagnosis among a provider's patients.
Conclusions:
- This study confirms ongoing variation in pediatric provider practice patterns, even with established guidelines.
- A significant linear correlation exists between multiple provider behaviors, suggesting an underlying practice philosophy.
- These findings highlight opportunities for personalized, provider-specific education and quality improvement interventions.
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