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Analysis of a high-prescribing state’s 2016 outpatient antibiotic prescriptions: Implications for outpatient antimicrobial stewardship interventions

Published online by Cambridge University Press:  22 November 2019

Milner B. Staub Open the ORCID record for Milner B. Staub [Opens in a new window] ,
Youssoufou Ouedraogo ,
Christopher D. Evans ,
Sophie E. Katz ,
Pamela P. Talley ,
Marion A. Kainer  and
George E. Nelson
Milner B. Staub*
Affiliation:
Veterans Health Administration, Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
Youssoufou Ouedraogo
Affiliation:
Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Health, Nashville, Tennessee
Christopher D. Evans
Affiliation:
Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Health, Nashville, Tennessee
Sophie E. Katz
Affiliation:
Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
Pamela P. Talley
Affiliation:
Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Health, Nashville, Tennessee
Marion A. Kainer
Affiliation:
Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Health, Nashville, Tennessee
George E. Nelson
Affiliation:
Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
*
Author for correspondence: Milner Staub, Email: milner.b.owens@gmail.com
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Abstract

Objective:

To identify prescriber characteristics that predict antibiotic high-prescribing behavior to inform statewide antimicrobial stewardship interventions.

Design:

Retrospective analysis of 2016 IQVIA Xponent, formerly QuintilesIMS, outpatient retail pharmacy oral antibiotic prescriptions in Tennessee.

Setting:

Statewide retail pharmacies filling outpatient antibiotic prescriptions.

Participants:

Prescribers who wrote at least 1 antibiotic prescription filled at a retail pharmacy in Tennessee in 2016.

Methods:

Multivariable logistic regression, including prescriber gender, birth decade, specialty, and practice location, and patient gender and age group, to determine the association with high prescribing.

Results:

In 2016, 7,949,816 outpatient oral antibiotic prescriptions were filled in Tennessee: 1,195 prescriptions per 1,000 total population. Moreover, 50% of Tennessee’s outpatient oral antibiotic prescriptions were written by 9.3% of prescribers. Specific specialties and prescriber types were associated with high prescribing: urology (odds ratio [OR], 3.249; 95% confidence interval [CI], 3.208–3.289), nurse practitioners (OR, 2.675; 95% CI, 2.658–2.692), dermatologists (OR, 2.396; 95% CI, 2.365–2.428), physician assistants (OR, 2.382; 95% CI, 2.364–2.400), and pediatric physicians (OR, 2.340; 95% CI, 2.320–2.361). Prescribers born in the 1960s were most likely to be high prescribers (OR, 2.574; 95% CI, 2.532–2.618). Prescribers in rural areas were more likely than prescribers in all other practice locations to be high prescribers. High prescribers were more likely to prescribe broader-spectrum antibiotics (P < .001).

Conclusions:

Targeting high prescribers, independent of specialty, degree, practice location, age, or gender, may be the best strategy for implementing cost-conscious, effective outpatient antimicrobial stewardship interventions. More information about high prescribers, such as patient volumes, clinical scope, and specific barriers to intervention, is needed.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 2 , February 2020 , pp. 135 - 142
Creative Commons
This work is classified, for copyright purposes, as a work of the U.S. Government and is not subject to copyright protection within the United States.
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.

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Footnotes

PREVIOUS PRESENTATION: These data were presented at the Society for Healthcare Epidemiology of America Spring Meeting in an oral abstract on April 26, 2019, in Boston, Massachusetts.

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