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Author Notes:

Correspondence: S. Jung, MPH, Emory University, 1075 Trail Rd., Moscow, ID 83843 sjung64@alumni.emory.edu

Acknowledgments: We thank Dr. Zachary Binney and Michael Garber (Emory University) for their assistance.

Potential conflicts of interest. All authors: No reported conflicts of interest.

All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest.

Subjects:

Research Funding:

This article published with support from Emory Libraries' Open Access Publishing Fund.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Immunology
  • Infectious Diseases
  • Microbiology
  • epidemiology
  • primary care
  • quality improvement
  • RESPIRATORY-TRACT INFECTIONS
  • CLINICAL-PRACTICE GUIDELINE
  • AMBULATORY-CARE
  • ADULTS
  • POPULATION
  • COMMUNITY
  • RATES

Variability of Antibiotic Prescribing in a Large Healthcare Network Despite Adjusting for Patient-Mix: Reconsidering Targets for Improved Prescribing

Journal Title:

Open Forum Infectious Diseases

Volume:

Volume 6, Number 2

Publisher:

, Pages ofz018-ofz018

Type of Work:

Article | Final Publisher PDF

Abstract:

Background: In the outpatient setting, the majority of antibiotic prescriptions are for acute respiratory infections (ARIs), but most of these infections are viral and antibiotics are unnecessary. We analyzed provider-specific antibiotic prescribing in a group of outpatient clinics affiliated with an academic medical center to inform future interventions to minimize unnecessary antibiotic use. Methods: We conducted a cross-sectional study of patients who presented with an ARI to any of 15 The Emory Clinic (TEC) primary care clinic sites between October 2015 and September 2017. We performed multivariable logistic regression analysis to examine the impact of patient, provider, and clinic characteristics on antibiotic prescribing. We also compared provider-specific prescribing rates within and between clinic sites. Results: A total of 53.4% of the 9600 patient encounters with a diagnosis of ARI resulted in an antibiotic prescription. The odds of an encounter resulting in an antibiotic prescription were independently associated with patient characteristics of white race (adjusted odds ratio [aOR] = 1.59; 95% confidence interval [CI], 1.47-1.73), older age (aOR = 1.32, 95% CI = 1.20-1.46 for patients 51 to 64 years; aOR = 1.32, 95% CI = 1.20-1.46 for patients ≥65 years), and comorbid condition presence (aOR = 1.19; 95% CI, 1.09-1.30). Of the 109 providers, 13 (12%) had a rate significantly higher than predicted by modeling. Conclusions: Antibiotic prescribing for ARIs within TEC outpatient settings is higher than expected based on prescribing guidelines, with substantial variation in prescribing rates by site and provider. These data lay the foundation for quality improvement interventions to reduce unnecessary antibiotic prescribing.
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