Regional variability in outpatient antibiotic use in Ontario, Canada: a retrospective cross-sectional study

Abstract

Background: Regional variability in antibiotic use is associated with both antibiotic overuse and antimicrobial resistance. Our objectives were to benchmark outpatient antibiotic use and to evaluate geographic variability among health regions in the province of Ontario, Canada. Methods: This was a cross-sectional study of antibiotics dispensed from outpatient retail pharmacies in Ontario between March 2016 and February 2017. We analyzed variability in the number of antibiotic prescriptions dispensed per 1000 population among Ontario's 14 health regions with crude and adjusted Poisson regression models. Adjusted models controlled for rurality, 4 physician characteristics and 6 population characteristics. Results: There were 8 352 578 antibiotics dispensed during the 1-year study period or 621 per 1000 population. The most commonly prescribed antibiotic classes were narrow-spectrum penicillins, macrolides, first-generation cephalosporins and second-generation fluoroquinolones, with adult women receiving the highest rate of prescriptions: 985 antibiotic prescriptions per 1000 population. There was geographic variability in total and class-specific antibiotic use. In the health region with the highest use 778 antibiotics were dispensed per 1000 population whereas in the health region with the lowest use 534 antibiotics were dispensed per 1000 population. The adjusted marginal standardized antibiotic prescription rates for the health regions with the highest and lowest use were 787 (95% confidence interval [CI] 658-934) and 546 (95% CI 494-606) antibiotic prescriptions per 1000 population, respectively. Interpretation: We described baseline antibiotic usage in Ontario over a 12-month period, noting variability among some health regions. Our findings highlight the need for interventions to optimize antibiotic use and slow the emergence of antimicrobial resistance.

Unnecessary antibiotic prescribing in a Canadian primary care setting: a descriptive analysis using routinely collected electronic medical record data

“…For context, the rate of antibiotic use in the US is 838 prescriptions per 1000 people annually, 24 compared to 625 in Canada, 25 621 in Ontario, 26 626 in England 27 and 325 in Sweden. 28 We observed an antibiotic prescribing rate for the common cold of 18%, comparable to the rate of 25% observed in a similar study conducted in the UK.…”

Defining appropriate antibiotic prescribing in primary care: A modified Delphi panel approach

“…Conducting antimicrobial stewardship in the community to optimize antibiotic use is a national priority (1). Localized assessment of unnecessary antibiotic use is essential because of the large regional variability in antibiotic use, and it is likely much of this variability is driven by differences in inappropriate use (16,17). These results can be used to establish realistic and safe targets for reduction in community antibiotic use.…”

Validating a popular outpatient antibiotic database to reliably identify high prescribing physicians for patients 65 years of age and older

“…Various forms of antibiotic use data are available including dispensing data compiled by pharmacies (e.g. National Prescription Audit ® CompuScript ® or GPM ® )[7] [8] or funders (e.g. Ontario Drug Benefit) [9] which can be population based.…”

“…IQVIA maintains a variety of prescription drug databases. In the United States (U.S.) and Canada, the IQVIA Xponent database is derived from 65–70% of the populations’ dispensed prescriptions [7,13] IQVIA then applies a proprietary geospatial extrapolation algorithm. The data are then sold to third parties representing 100% complete prescription data.…”