Influence of provider and urgent care density across different socioeconomic strata on outpatient antibiotic prescribing in the USA

Klein, Eili Y.; Makowsky, Michael D.; Orlando, Megan S.; Hatna, Erez; Braykov, Nikolay P.; Laxminarayan, Ramanan

doi:10.1093/jac/dku563

Cited by 41 publications

(31 citation statements)

References 30 publications

(37 reference statements)

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“…It is uncertain whether states with higher antibiotic prescribing rates have more inclusive criteria for a septicemia diagnosis (boosting the association between antibiotic prescribing rates and septicemia hospitalization rates), or vice versa. For example, California has relatively low antibiotic prescribing rates [52] and apparently more inclusive criteria for a septicemia/sepsis diagnosis that translate into lower case fatality rates for such hospitalizations compared to the national average, e.g. [53].…”

Section: Discussionmentioning

confidence: 99%

Levels of outpatient prescribing for four major antibiotic classes and rates of septicemia hospitalization in adults in different US states

Goldstein

Olesen

Karaca

et al. 2018

Preprint

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Background: Rates of sepsis/septicemia hospitalization in the US have risen significantly during recent years, and antibiotic resistance and use may contribute to those rates through various mechanisms.Methods: We used multivariable linear regression to relate state-specific rates of outpatient prescribing overall for fluoroquinolones, penicillins, macrolides, and cephalosporins between 2011-2012 to state-specific rates of hospitalization with septicemia (ICD-9 codes 038.xx present anywhere on discharge diagnosis) in each of the following age groups of adults: (18-49y, 50-64y, 65-74y, 75-84y, 85+y) reported to the Healthcare Cost and Utilization Project (HCUP) between 2011-2012, adjusting for additional covariates, and random effects associated with the ten US Health and Human Services (HHS) regions.Results: Rates of penicillin prescribing were positively associated with septicemia hospitalization rates in the analyses for persons aged 50-64y, 65-74y, and 74-84y. Percent African Americans in a given age group was positively associated with septicemia hospitalization rates in the analyses for persons aged 75-84y and over 85y. Average minimal daily temperature was positively associated with septicemia hospitalization rates in the analyses for persons aged 18-49y, 50-64y, 75-84y and over 85y. Conclusions: Our results suggest positive associations between the rates of prescribing for penicillins and the rates of sepsis hospitalization in US adults aged 50-84y. Further studies are needed to understand the potential effect of antibiotic replacement in the treatment of various syndromes, such as replacement of fluoroquinolones by other antibiotics, possibly penicillins following the recent US FDA guidelines on restriction of fluoroquinolone use, on the rates of sepsis hospitalization.

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Section: Discussionmentioning

confidence: 99%

Levels of outpatient prescribing for four major antibiotic classes and rates of septicemia hospitalization in adults in different US states

Goldstein

Olesen

Karaca

et al. 2018

Preprint

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“…Indeed, other work has shown that where provider density is higher, inappropriate antimicrobial prescribing is higher. 32,33 …”

Section: Discussionmentioning

confidence: 99%

Phantom Prescribing: Examining the Frequency of Antimicrobial Prescriptions Without a Patient Visit

Riedle

Polgreen

Cavanaugh

et al. 2016

Infect. Control Hosp. Epidemiol.

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Objective To investigate the scale of antimicrobial prescribing without a corresponding visit, and to compare the attributes of patients who received antimicrobials with a corresponding visit to those who did not have a visit. Design Retrospective cohort Methods We followed 185,010 Medicare patients for one year after an acute myocardial infarction. For each antimicrobial prescribed, we determined if the patient had an inpatient, outpatient or provider claim in the 7 days prior to the antimicrobial prescription being filled. We compared the proportions of patient characteristics for those prescriptions associated with a visit and without a visit (i.e., phantom prescriptions). We also compared the rates at which different antimicrobials were prescribed without a visit. Results We found that of 356,545 antimicrobial prescriptions, 14.75% had no evidence of a visit in the week prior to the prescription being filled. A higher percentage of patients without a visit were identified as white (p<0.001) and female (p<0.001). Patients without a visit had a higher likelihood of survival and fewer additional cardiac events (AMI, cardiac arrest, stroke, all p<0.001). Among the antimicrobials considered, amoxicillin, penicillin, and agents containing trimethoprim and methenamine were much more likely to be prescribed without a visit. In contrast, levofloxacin, metronidazole, moxifoxacin, vancomycin, and cefdinir were much less likely to be prescribed without a visit. Conclusions Among this cohort of patients with chronic conditions, phantom prescriptions of antimicrobials are relatively common and occurred more frequently among those patients who were relatively healthy.

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“…In Europe, these geographical variations have been attributed to socioeconomic (eg, financial wellbeing and access to health insurance), sociodemographic (eg, urbanization), and cultural (eg, educational level, prescribing norms, and patient demands) factors. 8,9 Furthermore, there is evidence that antibiotic prescription rates vary considerably according to age and sex. 5,10 In Italy, where the consumption of systemic antibiotics is higher than the European average, 2,11,12 antibiotic prescription rates vary among different regions, 5,13,14 showing a higher antibiotic consumption in Southern Italy.…”

Section: Introductionmentioning

confidence: 99%

<p>Drug Utilization Pattern of Antibiotics: The Role of Age, Sex and Municipalities in Determining Variation</p>

Orlando

Monetti

Juste

et al. 2020

RMHP

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Purpose: The purpose was to analyze drug prescription and antibiotic use by age and sex in Italy's Campania Region, and to estimate the distribution of prescription rates in children (≤14 years old), adults (between 15 and 65 years old), and older adults (≥65 years old) at a municipality level. Methods: This was a retrospective analysis of pharmacy records in Campania (Southern Italy), in 2016. Difference in antibiotic prescriptions in different age groups was assessed by prevalence rates. Age-adjusted prevalence rates were categorized into quintiles and mapped by the patient's municipality of residence. Relationship between prevalence rates for the different age groups was estimated using the non-parametric Spearman rank correlation test. Results: There were 2,738,118 were patients with at least one antibiotic prescription. Antibiotics prescription was higher in children aged <5 years and in the older adults aged >70 years. Prevalence rate distribution was different among municipalities in all age groups. A positive correlation between the rank distribution of prevalence rates at municipality level was identified for children and adults (rs=0.56; P<0.01), adults and the older adults (rs=0.79; P<0.01), and children and the older adults (rs=0.46; P<0.01). Among the studied age groups, the most prescribed antibiotic class was penicillin (except the older adults aged ≥85 years) ranging from 45% in children to 27.2% in the older adults. Fluoroquinolones were the least prescribed antibiotic class, ranging from 0.2% in children to 30.2% in the older adults. Conclusion: A considerably high use of antibiotic drugs has been detected in Campania Region, with values exceeding the regional and national average. Prescriptions at municipal level differ from one age group to another. Antibiotic use is often unjustified, and to decrease the number of prescriptions and improve their appropriateness, several measures at territorial level are recommended.

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Influence of provider and urgent care density across different socioeconomic strata on outpatient antibiotic prescribing in the USA

Abstract: In areas with higher poverty rates, access to providers drives the prescribing rate. However, in wealthier areas, where access is less of a problem, a higher density of providers and clinics increases the prescribing rate, potentially due to competition.

Cited by 41 publications

References 30 publications

Levels of outpatient prescribing for four major antibiotic classes and rates of septicemia hospitalization in adults in different US states

Levels of outpatient prescribing for four major antibiotic classes and rates of septicemia hospitalization in adults in different US states

Phantom Prescribing: Examining the Frequency of Antimicrobial Prescriptions Without a Patient Visit

<p>Drug Utilization Pattern of Antibiotics: The Role of Age, Sex and Municipalities in Determining Variation</p>

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