Association between Physician Intensity of Antibiotic Prescribing and the Prescription of Benzodiazepines, Opioids and Proton-Pump Inhibitors to Nursing Home Residents: a Population-Based Observational Study.
Analgesics, Opioid
/ administration & dosage
Anti-Bacterial Agents
/ administration & dosage
Benzodiazepines
/ administration & dosage
Drug Prescriptions
/ statistics & numerical data
Female
Humans
Long-Term Care
/ statistics & numerical data
Male
Nursing Homes
/ statistics & numerical data
Ontario
/ epidemiology
Population Surveillance
Practice Patterns, Physicians'
/ statistics & numerical data
Proton Pump Inhibitors
/ administration & dosage
anti-bacterial agents
drug prescriptions
inappropriate prescribing
nursing home
physicians practice patterns
Journal
Journal of general internal medicine
ISSN: 1525-1497
Titre abrégé: J Gen Intern Med
Pays: United States
ID NLM: 8605834
Informations de publication
Date de publication:
12 2019
12 2019
Historique:
received:
08
01
2019
accepted:
21
08
2019
revised:
11
07
2019
pubmed:
3
10
2019
medline:
28
11
2020
entrez:
3
10
2019
Statut:
ppublish
Résumé
Prescribing patterns for episodic medications, such as antibiotics, might make useful surrogate measures of a physician's overall prescribing practice because use is common, and variation exists across prescribers. However, the extent to which a physician's current antibiotic prescribing practices are associated with the rate of prescription of other potentially harmful medications remains unknown. To examine the association between a physician's rate of antibiotic prescribing and their prescribing rate of benzodiazepines, opioids and proton-pump inhibitors in older adults. Population-based cohort study in nursing homes in Ontario, Canada, which provides comprehensive clinical, behavioural and functional information on all patients. 1926 physicians who provided care among 128,979 physician-patient pairs in 2015. Likelihood of prescribing a benzodiazepine, opioid or proton-pump inhibitor between low-, average- and high-intensity antibiotic prescribers, adjusted for patient characteristics. Compared with average-intensity antibiotic prescribers, high-intensity prescribers had an increased likelihood of prescribing a benzodiazepine (odds ratio 1.21 [95% CI, 1.11-1.32]), an opioid (odds ratio 1.28 [95% CI, 1.17-1.39]) or a proton-pump inhibitor (odds ratio 1.38 [95% CI, 1.27-1.51]]. High-intensity antibiotic prescribers were more likely to be high prescribers of all three medications (odds ratio 6.24 [95% CI, 2.90-13.39]) and also more likely to initiate all three medications, compared with average-intensity prescribers. The intensity of a physician's episodic antibiotic prescribing was significantly associated with the likelihood of new and continued prescribing of opioids, benzodiazepines and proton-pump inhibitors in nursing homes. Patterns of episodic prescribing may be a useful mechanism to target physician-level interventions to optimize general prescribing behaviors, instead of prescribing behaviors for single medications.
Sections du résumé
BACKGROUND
Prescribing patterns for episodic medications, such as antibiotics, might make useful surrogate measures of a physician's overall prescribing practice because use is common, and variation exists across prescribers. However, the extent to which a physician's current antibiotic prescribing practices are associated with the rate of prescription of other potentially harmful medications remains unknown.
OBJECTIVE
To examine the association between a physician's rate of antibiotic prescribing and their prescribing rate of benzodiazepines, opioids and proton-pump inhibitors in older adults.
DESIGN
Population-based cohort study in nursing homes in Ontario, Canada, which provides comprehensive clinical, behavioural and functional information on all patients.
PARTICIPANTS
1926 physicians who provided care among 128,979 physician-patient pairs in 2015.
MAIN MEASURES
Likelihood of prescribing a benzodiazepine, opioid or proton-pump inhibitor between low-, average- and high-intensity antibiotic prescribers, adjusted for patient characteristics.
KEY RESULTS
Compared with average-intensity antibiotic prescribers, high-intensity prescribers had an increased likelihood of prescribing a benzodiazepine (odds ratio 1.21 [95% CI, 1.11-1.32]), an opioid (odds ratio 1.28 [95% CI, 1.17-1.39]) or a proton-pump inhibitor (odds ratio 1.38 [95% CI, 1.27-1.51]]. High-intensity antibiotic prescribers were more likely to be high prescribers of all three medications (odds ratio 6.24 [95% CI, 2.90-13.39]) and also more likely to initiate all three medications, compared with average-intensity prescribers.
CONCLUSIONS
The intensity of a physician's episodic antibiotic prescribing was significantly associated with the likelihood of new and continued prescribing of opioids, benzodiazepines and proton-pump inhibitors in nursing homes. Patterns of episodic prescribing may be a useful mechanism to target physician-level interventions to optimize general prescribing behaviors, instead of prescribing behaviors for single medications.
Identifiants
pubmed: 31576508
doi: 10.1007/s11606-019-05333-8
pii: 10.1007/s11606-019-05333-8
pmc: PMC6854144
doi:
Substances chimiques
Analgesics, Opioid
0
Anti-Bacterial Agents
0
Proton Pump Inhibitors
0
Benzodiazepines
12794-10-4
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2763-2771Subventions
Organisme : CIHR
ID : MOP-136854
Pays : Canada
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