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Antibiotic Prescribing Practices for Upper Respiratory Tract Infections Among Primary Care Providers: A Descriptive
Liton Chandra Deb1, Brenda M McGrath1, Levi Schlosser2
1Department of Public Health, North Dakota State University, Fargo, North Dakota, USA.
Background:
Most antibiotics are prescribed in the ambulatory setting with estimates that up to 50% of use is inappropriate. Understanding factors associated with antibiotic misuse is essential to advancing better stewardship in this setting. We sought to assess the frequency of unnecessary antibiotic use for upper respiratory infections (URIs) among primary care providers and identify patient and provider characteristics associated with misuse.
Methods:
Unnecessary antibiotic prescribing was assessed in a descriptive study by using adults ≥18 years seen for common URIs in a large, Upper Midwest, integrated health system, electronic medical records from June 2017 through May 2018. Individual provider rates of unnecessary prescribing were compared for primary care providers practicing in the departments of internal medicine, family medicine, or urgent care. Patient and provider characteristics associated with unnecessary prescribing were identified with a logistic regression model.
Results:
A total of 49 463 patient encounters were included. Overall, antibiotics were prescribed unnecessarily for 42.2% (95% confidence interval [CI], 41.7-42.6) of the encounters. Patients with acute bronchitis received unnecessary antibiotics most frequently (74.2%; 95% CI, 73.4-75.0). Males and older patients were more likely to have an unnecessary antibiotic prescription. Provider characteristics associated with higher rates of unnecessary prescribing included being in a rural practice, having more years in practice, and being in higher volume practices such as an urgent care setting. Fifteen percent of providers accounted for half of all unnecessary antibiotic prescriptions.
Conclusions:
Although higher-volume practices, a rural setting, or longer time in practice were predictors, unnecessary prescribing was common among all providers.
Insights
Antibiotic misuse for upper respiratory infections (URIs) is common, with 42.2% of prescriptions being unnecessary. Factors like patient demographics and provider setting influence this inappropriate antibiotic use, highlighting a need for better stewardship.
Area of Science:
- Infectious Diseases
- Primary Care Medicine
- Health Services Research
Background:
- Antibiotic prescribing is frequent in ambulatory settings, with up to 50% deemed inappropriate.
- Understanding drivers of antibiotic misuse is crucial for improving stewardship in primary care.
- This study focuses on unnecessary antibiotic use for upper respiratory infections (URIs).
Purpose of the Study:
- To determine the frequency of unnecessary antibiotic prescribing for URIs by primary care providers.
- To identify patient and provider characteristics associated with unnecessary antibiotic prescriptions.
Main Methods:
- A descriptive study analyzed electronic medical records from June 2017 to May 2018.
- Included were adult patients (≥18 years) with common URIs in a large health system.
- Logistic regression identified factors linked to unnecessary prescribing.
Main Results:
- 49,463 encounters were analyzed; 42.2% of antibiotic prescriptions were unnecessary.
- Acute bronchitis cases had the highest rate of unnecessary antibiotic use (74.2%).
- Older males and patients in rural practices with more experienced providers showed higher rates of unnecessary prescribing.
Conclusions:
- Unnecessary antibiotic prescribing for URIs is prevalent across primary care providers.
- Provider experience, practice setting (rural, urgent care), and patient demographics are associated with misuse.
- A small percentage of providers accounted for a large proportion of unnecessary prescriptions, indicating targeted interventions may be effective.
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