The Association Between High and Unnecessary Antibiotic Prescribing: A Cohort Study Using Family Physician Electronic Medical Records.

Anti-Bacterial Agents / therapeutic use Cohort Studies Electronic Health Records Humans Inappropriate Prescribing Ontario Physicians, Family Practice Patterns, Physicians'
antibiotic antimicrobial stewardship family physician multilevel regression analysis

Journal

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213

Informations de publication

Date de publication:
04 05 2021
Historique:
received: 13 05 2020
pubmed: 14 8 2020
medline: 21 5 2021
entrez: 14 8 2020
Statut: ppublish

Résumé

Approximately 25% of outpatient antibiotic prescriptions are unnecessary among family physicians in Canada. Minimizing unnecessary antibiotics is key for community antibiotic stewardship. However, unnecessary antibiotic prescribing is much harder to measure than total antibiotic prescribing. We investigated the association between total and unnecessary antibiotic use by family physicians and evaluated inter-physician variability in unnecessary antibiotic prescribing. This was a cohort study based on electronic medical records of family physicians in Ontario, Canada, between April 2011 and March 2016. We used predefined expected antibiotic prescribing rates for 23 common primary care conditions to calculate unnecessary antibiotic prescribing rates. We used multilevel Poisson regression models to evaluate the association between total antibiotic volume (number of antibiotic prescriptions per patient visit), adjusted for multiple practice- and physician-level covariates, and unnecessary antibiotic prescribing. There were 499 570 physician-patient encounters resulting in 152 853 antibiotic prescriptions from 341 physicians. Substantial inter-physician variability was observed. In the fully adjusted model, we observed a significant association between total antibiotic volume and unnecessary prescribing rate (adjusted rate ratio 2.11 per 10% increase in total use; 95% CI 2.05-2.17), and none of the practice- and physician-level variables were associated with unnecessary prescribing rate. We demonstrated substantial inter-physician variability in unnecessary antibiotic prescribing in this cohort of family physicians. Total antibiotic use was strongly correlated with unnecessary antibiotic prescribing. Total antibiotic volume is a reasonable surrogate for unnecessary antibiotic use. These results can inform community antimicrobial stewardship efforts.

Sections du résumé

BACKGROUND
Approximately 25% of outpatient antibiotic prescriptions are unnecessary among family physicians in Canada. Minimizing unnecessary antibiotics is key for community antibiotic stewardship. However, unnecessary antibiotic prescribing is much harder to measure than total antibiotic prescribing. We investigated the association between total and unnecessary antibiotic use by family physicians and evaluated inter-physician variability in unnecessary antibiotic prescribing.
METHODS
This was a cohort study based on electronic medical records of family physicians in Ontario, Canada, between April 2011 and March 2016. We used predefined expected antibiotic prescribing rates for 23 common primary care conditions to calculate unnecessary antibiotic prescribing rates. We used multilevel Poisson regression models to evaluate the association between total antibiotic volume (number of antibiotic prescriptions per patient visit), adjusted for multiple practice- and physician-level covariates, and unnecessary antibiotic prescribing.
RESULTS
There were 499 570 physician-patient encounters resulting in 152 853 antibiotic prescriptions from 341 physicians. Substantial inter-physician variability was observed. In the fully adjusted model, we observed a significant association between total antibiotic volume and unnecessary prescribing rate (adjusted rate ratio 2.11 per 10% increase in total use; 95% CI 2.05-2.17), and none of the practice- and physician-level variables were associated with unnecessary prescribing rate.
CONCLUSIONS
We demonstrated substantial inter-physician variability in unnecessary antibiotic prescribing in this cohort of family physicians. Total antibiotic use was strongly correlated with unnecessary antibiotic prescribing. Total antibiotic volume is a reasonable surrogate for unnecessary antibiotic use. These results can inform community antimicrobial stewardship efforts.

Identifiants

DOI: 10.1093/cid/ciaa1139 PMID: 32785696
pubmed: 32785696
pii: 5891781
doi: 10.1093/cid/ciaa1139
doi:

Substances chimiques

Anti-Bacterial Agents 0

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

e345-e351

Informations de copyright

© Queen’s Printer for Ontario, 2020.

Auteurs

Taito Kitano (T)

The Hospital for Sick Children, Toronto, Ontario, Canada.
ORCID: 0000-0003-0623-066X

Bradley J Langford (BJ)

Public Health Ontario, Toronto, Ontario, Canada.

Kevin A Brown (KA)

Public Health Ontario, Toronto, Ontario, Canada.
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
ICES, Toronto, Ontario, Canada.

Andrea Pang (A)

ICES, Toronto, Ontario, Canada.

Branson Chen (B)

ICES, Toronto, Ontario, Canada.

Gary Garber (G)

Public Health Ontario, Toronto, Ontario, Canada.
Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.

Nick Daneman (N)

Public Health Ontario, Toronto, Ontario, Canada.
ICES, Toronto, Ontario, Canada.
Sunnybrook Research Institute, Toronto, Ontario, Canada.

Karen Tu (K)

Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada.
North York General Hospital, Toronto, Ontario, Canada.
Toronto Western Hospital Family Health Team, University Health Network, Toronto, Ontario, Canada.

Valerie Leung (V)

Public Health Ontario, Toronto, Ontario, Canada.
Toronto East Health Network, Michael Garron Hospital, Toronto, Ontario, Canada.

Elisa Candido (E)

ICES, Toronto, Ontario, Canada.

Julie Hui-Chih Wu (JH)

Public Health Ontario, Toronto, Ontario, Canada.

Jeremiah Hwee (J)

Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada.

Michael Silverman (M)

London Health Sciences Centre, London, Ontario, Canada.

Kevin L Schwartz (KL)

Public Health Ontario, Toronto, Ontario, Canada.
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
ICES, Toronto, Ontario, Canada.
Unity Health Network, St. Joseph Health Centre, Toronto, Ontario, Canada.

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Classifications MeSH

questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Anti-infectieux › Antibactériens › The Association Between High and Unnecessary...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › The Association Between High and Unnecessary...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Documents › Dossiers médicaux › Systèmes informatisés de dossiers médicaux › Dossiers médicaux électroniques › The Association Between High and Unnecessary...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › The Association Between High and Unnecessary...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Erreurs médicales › Erreurs de médication › Prescription inappropriée › The Association Between High and Unnecessary...
questionsmedicales.fr › Régions géographiques › Amériques › Amérique du Nord › Canada › Ontario › The Association Between High and Unnecessary...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Personnel de santé › Médecins › Médecins de famille › The Association Between High and Unnecessary...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Prestations des soins de santé › Types de pratiques des médecins › The Association Between High and Unnecessary...