Identifying and analyzing high-prescribers of opioids and antibiotics using medicare part D data

Excess prescribing of antibiotics and opioids is a major public health concern. A greater understanding of prescribing patterns at the prescriber and beneficiary level could inform enhanced and integrated interventions.

Using 2023 Medicare Part D Public Use data, we conducted a cross-sectional study to assess opioid and antibiotic prescribing patterns among primary care clinicians (internal medicine, family medicine, geriatrics, nurse practitioners, and physician assistants) in New York State (NYS) treating ≥20 Medicare beneficiaries aged ≥65. For each provider, the total days' supply of antibiotics and opioids per beneficiary was calculated. Multivariate logistic regression models identified provider and practice characteristics associated with high-prescribing.

Of the 19,823 eligible prescribers, 647 (3.3%) were high antibiotic prescribers and 554 (2.8%) were high opioid prescribers. Antibiotic high-prescribing was associated with nurse practitioners (NP) (adjusted odds ratio (aOR 2.47, 95% CI 1.83-3.34)), physician assistants (PA) (aOR 1.90, 95% CI 1.43-2.54), more years in practice (aOR 1.62 per SD, 95% CI 1.47-1.78), and panels with higher average beneficiary risk scores (aOR 1.36 per SD, 95% CI 1.29-1.43). Opioid high-prescribing was associated with geriatrics (aOR 4.30, 95% CI 1.79-10.32), NP (aOR 1.80, 95% CI 1.36-2.37), male gender (aOR 1.55, 95% CI 1.17-2.04).), greater years in practice (aOR 1.68, 95% CI 1.51-1.86), and higher proportions of dual-eligible beneficiaries (aOR 1.38, 95% CI 1.23-1.56).

A small number of NYS clinicians account for a disproportionate share of antibiotic and opioid prescribing. Identifying provider- and panel-level characteristics associated with higher prescribing may inform targeted stewardship strategies.