Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011

Murphy, Ryan Anne

doi:10.1016/j.jemermed.2016.07.019

Cited by 4 publications

(3 citation statements)

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“…Antibiotic prescribing patterns is a frequently studied healthcare quality metric given risk to patient safety with unnecessary exposure and adverse effects, 15 as well as contributing to antimicrobial resistance. 16 National rates of antibiotic prescriptions for ARS visits varies widely from 72% to 96%, 5,[17][18][19] which aligns with our findings in this study. Specifically, acute respiratory infections without a clear bacterial source are the most common cause for antibiotic prescriptions.…”

Section: Discussionsupporting

confidence: 89%

Antibiotic Prescribing for Acute Rhinosinusitis: In‐Person Versus Virtual Visits During Covid‐19

Miller

Bhattacharyya

2020

The Laryngoscope

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Objectives/Hypothesis: Determine if antibiotic prescribing patterns differ for in-person versus virtual clinic visits for acute rhinosinusitis (ARS).Study Design: Cross sectional study. Methods: All adult virtual clinical encounters from March to May 2020 with a principal diagnosis of ARS were reviewed for demographic data and the presence or absence of an antibiotic prescription during the coronavirus shut down in Massachusetts. In-person clinical encounters from March to May 2019 were similarly examined as a control. The rate of antibiotic prescription was compared between virtual (2020) and in-person ( 2019) visits for ARS diagnoses.Results: There were 2,075 patients in March to May 2020 and 3,654 patients March to May 2019 who received an ARS principal diagnosis at their virtual and in-person outpatient visits, respectively. There was a statistically significant lower rate of antibiotic prescriptions for ARS in 2020 (72.1%) versus 2019 (76.7%).The odds ratio for an antibiotic prescription for ARS was 0.783 (95% confidence interval, 0.693-0.86; P < .001) for patients seen in the 2020 cohort versus the 2019 cohort. The compared rates for antibiotic prescribing for 2020 versus 2019 were not different in individual month-to-month comparisons. When stratified by otolaryngology providers there was no statistically significant difference of antibiotic prescriptions between the 2019 and 2020 cohort (P = .781).Conclusions: During the massive transition to virtual visits for March to May 2020 due to the coronavirus pandemic shut down in Massachusetts, the total rate of outpatient antibiotic prescribing for ARS was lower in the virtual visit environment compared to the traditional in-person visit. In this scenario, telemedicine did not result in an increase in antibiotic prescribing despite the lack of an in-person physical exam.

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Section: Discussionsupporting

confidence: 89%

Antibiotic Prescribing for Acute Rhinosinusitis: In‐Person Versus Virtual Visits During Covid‐19

Miller

Bhattacharyya

2020

The Laryngoscope

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“…[22] Just as most people rate themselves as better than average drivers[23], doctors are likely to overestimate their medical judgment concerning diagnoses they consider on a daily basis. Although evidence suggests that about half of antibiotics ordered for acute respiratory conditions are inappropriate[24] during “Near Live” testing, most participants deemed the tool as one that might be useful for other less experienced providers but not useful to them.…”

Section: Discussionmentioning

confidence: 99%

“Think aloud” and “Near live” usability testing of two complex clinical decision support tools

Richardson

Mishuris

O'Connell

et al. 2017

International Journal of Medical Informatics

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Objectives Low provider adoption continues to be a significant barrier to realizing the potential of clinical decision support. “Think Aloud” and “Near Live” usability testing were conducted on two clinical decision support tools. Each was composed of an alert, a clinical prediction rule which estimated risk of either group A Streptococcus pharyngitis or pneumonia and an automatic order set based on risk. The objective of this study was to further understanding of the facilitators of usability and to evaluate the types of additional information gained from proceeding to “Near Live” testing after completing “Think Aloud”. Methods This was a qualitative observational study conducted at a large academic health care system with 12 primary care providers. During “Think Aloud” testing, participants were provided with written clinical scenarios and asked to verbalize their thought process while interacting with the tool. During “Near Live” testing participants interacted with a mock patient. Morae usability software was used to record full screen capture and audio during every session. Participant comments were placed into coding categories and analyzed for generalizable themes. Themes were compared across usability methods. Results “Think Aloud” and “Near Live” usability testing generated similar themes under the coding categories visibility, workflow, content, understand-ability and navigation. However, they generated significantly different themes under the coding categories usability, practical usefulness and medical usefulness. During both types of testing participants found the tool easier to use when important text was distinct in its appearance, alerts were passive and appropriately timed, content was up to date, language was clear and simple, and each component of the tool included obvious indicators of next steps. Participant comments reflected higher expectations for usability and usefulness during “Near Live” testing. For example, visit aids, such as automatically generated order sets, were felt to be less useful during “Near-Live” testing because they would not be all inclusive for the visit. Conclusions These complementary types of usability testing generated unique and generalizable insights. Feedback during “Think Aloud” testing primarily helped to improve the tools’ ease of use. The additional feedback from “Near Live” testing, which mimics a real clinical encounter, was helpful for eliciting key barriers and facilitators to provider workflow and adoption.

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“…This increase in broad-spectrum antibiotics has not slowed, as broad-spectrum antibiotic prescriptions have doubled from 2000 to 2010 [22]. In addition, it was recently discovered that at least 1 in 3 antibiotic prescriptions in the United States are unnecessary, and antibiotics are often deployed to treat viral infections [23].…”

Section: Metabolic Pathways Sulfonamidesmentioning

confidence: 99%

Broad-Spectrum Antibiotic Abuse and its Connection to Obesity

Czaja¹

2017

JNHFS

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The purpose of this review was to assess patterns of antibiotic prescriptions across the United States and evaluate their relationship with associated conditions. A focus on national antibiotic prescriptions and proposed side effects was studied from 1993-2008. State-to-state differences in antibiotic prescribing and associated patterns of obesity were studied from 2011-2014. Data for these study periods was extracted from the CDC and affiliated institutions. Correlation assessments between antibiotic prescription patterns and a set of variables related to the proposed mechanism of antibiotic effects were made. From 2011-2014, cephalosporin prescriptions demonstrated the strongest relationship with associated obesity rates, while beta-lactams (cephalosporins and penicillins) showed weaker relationships when taken as a holistic class. To make light of these results, drug use of Ceftriaxone, a broad-spectrum, third-generation cephalosporin and Amoxicillin, a narrow-spectrum penicillin, was compared from 1993 to 2008 in relation to the prevalence of various health conditions: obesity; diabetes mellitus; sleep disorders; endocrine, nutritional, metabolic diseases and immunity disorders; and infectious and parasitic diseases. Ceftriaxone demonstrated a strong, significant, and positive relationship with all of the above variables, except for parasitic and infectious diseases. By comparison, Amoxicillin showed weak and non-significant relationships with all of the above variables. Despite their correlational limitations, these results suggest that broad-spectrum antibiotics play a significant role in the development and persistence of many chronic conditions in the United States. A mechanism providing a hypothesized explanation for these results was proposed based on extensive literature review.

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Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011

Cited by 4 publications

References 0 publications

Antibiotic Prescribing for Acute Rhinosinusitis: In‐Person Versus Virtual Visits During Covid‐19

Antibiotic Prescribing for Acute Rhinosinusitis: In‐Person Versus Virtual Visits During Covid‐19

“Think aloud” and “Near live” usability testing of two complex clinical decision support tools

Broad-Spectrum Antibiotic Abuse and its Connection to Obesity

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