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Education, tobacco use associated with inappropriate antibiotic prescriptions
Less-educated or tobacco-using patients were more likely to be inappropriately prescribed antibiotics for an acute respiratory tract infection than their peers, according to a recently published analysis.
In addition, researchers found that care setting, geographic region, provider specialty and other patient characteristics were significant influences on antibiotic overprescribing.
Tamar F. Barlam
“Patients unnecessarily prescribed antibiotics for acute respiratory tract infections (ARTIs) are put at risk for adverse drug effects such as allergic reactions or Clostridium difficile infection,” Tamar F. Barlam, MD, MSc, director of the antimicrobial stewardship program at Boston Medical Center and associate professor of medicine at Boston University School of Medicine, and colleagues wrote. “Despite efforts to improve prescribing, inappropriate use remains commonplace. Further characterization of antibiotic prescribing for ARTIs in ambulatory settings is important to identify predictors of overprescribing.”
In their analysis, Barlam and colleagues reviewed data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey collected from 2006 to 2010. Using ICD-9-CM codes, they identified all cases of various ARTIs not typically treated with antibiotics, categorizing these as “appropriate” or “inappropriate” based on the indicated treatment. Cases were categorized by a number of patient- and health care-specific variables, some of which included patient age, sex, race, tobacco use, insurance, physician care specialty, practice location and care setting. Other variables, such as poverty, household income and attainment of a bachelor’s degree were quantified at the population level using patient ZIP codes and included in analyses for potential interactions.
Barlam and colleagues found that overprescribing was less prevalent when treating patients aged 18 years or younger (OR = 0.55; 95% CI, 0.46-0.65) or patients aged 45 years or older (OR = 0.63; 95% CI, 0.47-0.86). Inappropriate prescribing also was more frequent when treating current tobacco users (OR = 1.71; 95% CI, 1.38-2.12) as well as those living in the quartile of ZIP code areas with the lowest proportion of college-educated residents (OR = 1.41; 95% CI, 1.07-1.86). Patient insurance was an additional factor, with those paying out-of-pocket more likely to be inappropriately prescribed antibiotics than those privately insured (OR = 1.45; 95% CI, 1.17-1.81).
Both hospital and community practice visits more often resulted in inappropriately prescribed antibiotics than ED visits (hospital practice, OR = 1.64; 95% CI, 1.27-2.12; community practice, OR = 1.59; 95% CI, 1.26-2.01), the researchers wrote. These trends varied, however, when analyzing by geographic region, with emergency and hospital practice less often prescribing than community practices in the Northeast, hospital practices more often overprescribing in the Midwest, and EDs less likely to overprescribe in the South. Furthermore, general practice physicians more often prescribed inappropriately compared with medical or surgical subspecialist peers.
Barlam and colleagues wrote that while overall prescription practices remain suboptimal, these results identify various patient and health care factors that may benefit from intervention.
“A focus on educating the patient may be as, or more, effective as a focus on the provider, particularly if the provider believes he/she is responding to patient preferences,” the researchers wrote. “A concentrated effort to educate and involve patients in the treatment decisions for ARTIs should be a health care priority as a way to stem inappropriate antibiotic use.” – by Dave Muoio
Disclosure: The researchers report no relevant financial disclosures.