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Inappropriate antibiotic prescribing for acute respiratory illnesses in outpatient settings in New York City,
Celina N Santiago1, Katelynn Devinney1, Molly M Kratz1
1Bureau of Communicable Diseases, New York City Department of Health and Mental Hygiene, USA.
Background:
Inappropriate antibiotic prescribing contributes to antibiotic resistance threats. In outpatient settings, antibiotics are often incorrectly prescribed for acute respiratory illnesses (ARI). Characteristics associated with inappropriate antibiotic prescribing at New York City (NYC) outpatient ARI visits were assessed to identify opportunities for interventions.
Methods:
Using IQVIA's commercial Medical Claims and Longitudinal Prescription datasets, medical diagnosis codes identified outpatient visits for ARI during 2019-2022, which were linked to antibiotics obtained at a pharmacy (as a proxy for prescribed antibiotics) within 3 days post-visit. Univariate analyses were conducted describing visit, patient, and provider characteristics. Modified Poisson regression with robust error variance was used to calculate unadjusted relative risks (RR) and 95% CI for visit-level characteristics associated with inappropriate prescribing.
Results:
Among 3,493,444 ARI outpatient visits, 5.1% linked to an inappropriate antibiotic prescription. Among all ARI, bronchitis/bronchiolitis had the highest percentage (25.5% of bronchitis/bronchiolitis visits) and highest risk of inappropriate prescribing relative to asthma/allergy (RR: 18.03; 95% CI: 17.70, 18.38). Adults aged 65-79 years were over twice as likely to be prescribed inappropriate antibiotics relative to children (RR: 2.21; 95% CI: 2.17, 2.25). Inappropriate prescribing was highest in urgent care (8.4%) (RR: 1.25; 95% CI: 1.23, 1.27) relative to offices and among internal medicine physicians (8.0%); relative to these physicians, risk of inappropriate prescribing among all other physician specialties was lower.
Conclusions:
Inappropriate antibiotic prescribing at ARI outpatient visits was uncommon. Tailoring interventions to providers such as internal medicine physicians or those in urgent care settings may improve prescribing practices.
Insights
Inappropriate antibiotic prescribing for acute respiratory illnesses (ARI) occurred in 5.1% of New York City outpatient visits. Interventions targeting specific providers, like internal medicine physicians and urgent care settings, could improve antibiotic prescribing practices.
Area of Science:
- Public Health
- Infectious Diseases
- Health Services Research
Background:
- Inappropriate antibiotic prescribing is a major driver of antibiotic resistance.
- Acute respiratory illnesses (ARI) in outpatient settings are frequently treated with unnecessary antibiotics.
- Understanding prescribing patterns is crucial for developing targeted interventions.
Purpose of the Study:
- To assess characteristics associated with inappropriate antibiotic prescribing for ARI in New York City (NYC) outpatient settings.
- To identify specific patient, visit, and provider factors linked to suboptimal antibiotic use.
- To inform the development of interventions aimed at reducing antibiotic resistance threats.
Main Methods:
- Utilized IQVIA commercial claims and prescription data from 2019-2022 for NYC outpatient ARI visits.
- Linked medical diagnosis codes to antibiotic dispensations within 3 days as a proxy for prescribing.
- Employed modified Poisson regression to calculate relative risks (RR) for inappropriate prescribing associated with various characteristics.
Main Results:
- 5.1% of 3,493,444 ARI outpatient visits were linked to inappropriate antibiotic prescriptions.
- Bronchitis/bronchiolitis visits had the highest rate (25.5%) and risk (RR: 18.03) of inappropriate prescribing compared to asthma/allergy.
- Adults aged 65-79 (RR: 2.21) and urgent care settings (RR: 1.25) showed higher risks of inappropriate antibiotic use.
Conclusions:
- Inappropriate antibiotic prescribing for ARI in NYC outpatient settings was relatively uncommon.
- Targeted interventions for internal medicine physicians and urgent care settings may enhance antibiotic stewardship.
- Addressing provider-specific prescribing behaviors is key to combating antibiotic resistance.
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