Concordance between high antibiotic prescribing and high opioid prescribing among primary care physicians: a cross-sectional study.

Adult Analgesics, Opioid / therapeutic use Anti-Bacterial Agents / therapeutic use Cross-Sectional Studies Female Humans Male Middle Aged Ontario Physicians, Primary Care / statistics & numerical data Practice Patterns, Physicians' / statistics & numerical data

Journal

CMAJ open
ISSN: 2291-0026
Titre abrégé: CMAJ Open
Pays: Canada
ID NLM: 101620603

Informations de publication

Date de publication:
Historique:
entrez: 10 3 2021
pubmed: 11 3 2021
medline: 20 7 2021
Statut: epublish

Résumé

Antimicrobial resistance and opioid misuse both present major public health challenges, and identifying high prescribers of both of these agents can help provide a common target for intervention. We sought to determine the association between being a high prescriber of antibiotics and being a high prescriber of opioids in the primary care setting. We performed a cross-sectional study of the antibiotic- and opioid-prescribing habits of primary care physicians in Ontario, Canada between Mar. 1, 2017, and Feb. 28, 2018, using administrative databases. We defined high prescribers as the top quartile of antibiotic or opioid prescribers using 3 antibiotic-prescribing metrics (prescriptions per patient visit, proportion of prescriptions that were broad spectrum and proportion of prescriptions > 8 d) and 3 opioid-prescribing metrics (prescriptions per patients seen, proportion of prescriptions > 90 mg of morphine equivalents and proportion of prescriptions > 28 d). We tabulated agreement between prescribing metrics using the κ statistic. We included 9994 physicians. We observed minimal overlap between high antibiotic initiation and high opioid initiation (618 physicians [6.2%]) (κ = 0.00, 95% confidence interval -0.02 to 0.02). There was slight agreement between the antibiotic-prescribing indices and between the opioid-prescribing indices (within-class, range of κ 0.05 to 0.18). There was slight disagreement to slight agreement across antibiotic- and opioid-prescribing metrics (between-class, range of κ -0.09 to 0.16). Among primary care physicians, there was a lack of association between high antibiotic prescribing and high opioid prescribing. Our findings suggest that separate tailored approaches to antibiotic and opioid stewardship strategies are needed.

Sections du résumé

BACKGROUND
Antimicrobial resistance and opioid misuse both present major public health challenges, and identifying high prescribers of both of these agents can help provide a common target for intervention. We sought to determine the association between being a high prescriber of antibiotics and being a high prescriber of opioids in the primary care setting.
METHODS
We performed a cross-sectional study of the antibiotic- and opioid-prescribing habits of primary care physicians in Ontario, Canada between Mar. 1, 2017, and Feb. 28, 2018, using administrative databases. We defined high prescribers as the top quartile of antibiotic or opioid prescribers using 3 antibiotic-prescribing metrics (prescriptions per patient visit, proportion of prescriptions that were broad spectrum and proportion of prescriptions > 8 d) and 3 opioid-prescribing metrics (prescriptions per patients seen, proportion of prescriptions > 90 mg of morphine equivalents and proportion of prescriptions > 28 d). We tabulated agreement between prescribing metrics using the κ statistic.
RESULTS
We included 9994 physicians. We observed minimal overlap between high antibiotic initiation and high opioid initiation (618 physicians [6.2%]) (κ = 0.00, 95% confidence interval -0.02 to 0.02). There was slight agreement between the antibiotic-prescribing indices and between the opioid-prescribing indices (within-class, range of κ 0.05 to 0.18). There was slight disagreement to slight agreement across antibiotic- and opioid-prescribing metrics (between-class, range of κ -0.09 to 0.16).
INTERPRETATION
Among primary care physicians, there was a lack of association between high antibiotic prescribing and high opioid prescribing. Our findings suggest that separate tailored approaches to antibiotic and opioid stewardship strategies are needed.

Identifiants

DOI: 10.9778/cmajo.20200122 PMID: 33688025 PMC: PMC8034295
pubmed: 33688025
pii: 9/1/E175
doi: 10.9778/cmajo.20200122
pmc: PMC8034295
doi:

Substances chimiques

Analgesics, Opioid 0
Anti-Bacterial Agents 0

Types de publication

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

Langues

eng

Sous-ensembles de citation

IM

Pagination

E175-E180

Informations de copyright

© 2021 Joule Inc. or its licensors.

Déclaration de conflit d'intérêts

Competing interests: None declared.

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Auteurs

Bradley J Langford (BJ)

Public Health Ontario (Langford, Chen, Daneman, Brown, Johnstone, Wu, Leung, Garber, Schwartz), Toronto, Ont.; Hotel Dieu Shaver Health and Rehabilitation Centre (Langford), St. Catharines, Ont.; ICES Central (Chen, Gomes, Schwartz); Sunnybrook Health Sciences Centre (Daneman); Dalla Lana School of Public Health (Brown, Schwartz), University of Toronto; Keenan Research Centre of the Li Ka Shing Knowledge Institute (Gomes), St. Michael's Hospital; Sinai Health System (Johnstone); Michael Garron Hospital (Leung), Toronto East Health Network, Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont. bradley.langford@oahpp.ca.

Cynthia Chen (C)

Public Health Ontario (Langford, Chen, Daneman, Brown, Johnstone, Wu, Leung, Garber, Schwartz), Toronto, Ont.; Hotel Dieu Shaver Health and Rehabilitation Centre (Langford), St. Catharines, Ont.; ICES Central (Chen, Gomes, Schwartz); Sunnybrook Health Sciences Centre (Daneman); Dalla Lana School of Public Health (Brown, Schwartz), University of Toronto; Keenan Research Centre of the Li Ka Shing Knowledge Institute (Gomes), St. Michael's Hospital; Sinai Health System (Johnstone); Michael Garron Hospital (Leung), Toronto East Health Network, Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont.

Nick Daneman (N)

Public Health Ontario (Langford, Chen, Daneman, Brown, Johnstone, Wu, Leung, Garber, Schwartz), Toronto, Ont.; Hotel Dieu Shaver Health and Rehabilitation Centre (Langford), St. Catharines, Ont.; ICES Central (Chen, Gomes, Schwartz); Sunnybrook Health Sciences Centre (Daneman); Dalla Lana School of Public Health (Brown, Schwartz), University of Toronto; Keenan Research Centre of the Li Ka Shing Knowledge Institute (Gomes), St. Michael's Hospital; Sinai Health System (Johnstone); Michael Garron Hospital (Leung), Toronto East Health Network, Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont.

Kevin A Brown (KA)

Public Health Ontario (Langford, Chen, Daneman, Brown, Johnstone, Wu, Leung, Garber, Schwartz), Toronto, Ont.; Hotel Dieu Shaver Health and Rehabilitation Centre (Langford), St. Catharines, Ont.; ICES Central (Chen, Gomes, Schwartz); Sunnybrook Health Sciences Centre (Daneman); Dalla Lana School of Public Health (Brown, Schwartz), University of Toronto; Keenan Research Centre of the Li Ka Shing Knowledge Institute (Gomes), St. Michael's Hospital; Sinai Health System (Johnstone); Michael Garron Hospital (Leung), Toronto East Health Network, Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont.

Tara Gomes (T)

Public Health Ontario (Langford, Chen, Daneman, Brown, Johnstone, Wu, Leung, Garber, Schwartz), Toronto, Ont.; Hotel Dieu Shaver Health and Rehabilitation Centre (Langford), St. Catharines, Ont.; ICES Central (Chen, Gomes, Schwartz); Sunnybrook Health Sciences Centre (Daneman); Dalla Lana School of Public Health (Brown, Schwartz), University of Toronto; Keenan Research Centre of the Li Ka Shing Knowledge Institute (Gomes), St. Michael's Hospital; Sinai Health System (Johnstone); Michael Garron Hospital (Leung), Toronto East Health Network, Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont.

Jennie Johnstone (J)

Public Health Ontario (Langford, Chen, Daneman, Brown, Johnstone, Wu, Leung, Garber, Schwartz), Toronto, Ont.; Hotel Dieu Shaver Health and Rehabilitation Centre (Langford), St. Catharines, Ont.; ICES Central (Chen, Gomes, Schwartz); Sunnybrook Health Sciences Centre (Daneman); Dalla Lana School of Public Health (Brown, Schwartz), University of Toronto; Keenan Research Centre of the Li Ka Shing Knowledge Institute (Gomes), St. Michael's Hospital; Sinai Health System (Johnstone); Michael Garron Hospital (Leung), Toronto East Health Network, Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont.

Julie Wu (J)

Public Health Ontario (Langford, Chen, Daneman, Brown, Johnstone, Wu, Leung, Garber, Schwartz), Toronto, Ont.; Hotel Dieu Shaver Health and Rehabilitation Centre (Langford), St. Catharines, Ont.; ICES Central (Chen, Gomes, Schwartz); Sunnybrook Health Sciences Centre (Daneman); Dalla Lana School of Public Health (Brown, Schwartz), University of Toronto; Keenan Research Centre of the Li Ka Shing Knowledge Institute (Gomes), St. Michael's Hospital; Sinai Health System (Johnstone); Michael Garron Hospital (Leung), Toronto East Health Network, Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont.

Valerie Leung (V)

Public Health Ontario (Langford, Chen, Daneman, Brown, Johnstone, Wu, Leung, Garber, Schwartz), Toronto, Ont.; Hotel Dieu Shaver Health and Rehabilitation Centre (Langford), St. Catharines, Ont.; ICES Central (Chen, Gomes, Schwartz); Sunnybrook Health Sciences Centre (Daneman); Dalla Lana School of Public Health (Brown, Schwartz), University of Toronto; Keenan Research Centre of the Li Ka Shing Knowledge Institute (Gomes), St. Michael's Hospital; Sinai Health System (Johnstone); Michael Garron Hospital (Leung), Toronto East Health Network, Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont.

Gary Garber (G)

Public Health Ontario (Langford, Chen, Daneman, Brown, Johnstone, Wu, Leung, Garber, Schwartz), Toronto, Ont.; Hotel Dieu Shaver Health and Rehabilitation Centre (Langford), St. Catharines, Ont.; ICES Central (Chen, Gomes, Schwartz); Sunnybrook Health Sciences Centre (Daneman); Dalla Lana School of Public Health (Brown, Schwartz), University of Toronto; Keenan Research Centre of the Li Ka Shing Knowledge Institute (Gomes), St. Michael's Hospital; Sinai Health System (Johnstone); Michael Garron Hospital (Leung), Toronto East Health Network, Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont.

Kevin L Schwartz (KL)

Public Health Ontario (Langford, Chen, Daneman, Brown, Johnstone, Wu, Leung, Garber, Schwartz), Toronto, Ont.; Hotel Dieu Shaver Health and Rehabilitation Centre (Langford), St. Catharines, Ont.; ICES Central (Chen, Gomes, Schwartz); Sunnybrook Health Sciences Centre (Daneman); Dalla Lana School of Public Health (Brown, Schwartz), University of Toronto; Keenan Research Centre of the Li Ka Shing Knowledge Institute (Gomes), St. Michael's Hospital; Sinai Health System (Johnstone); Michael Garron Hospital (Leung), Toronto East Health Network, Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Concordance between high antibiotic...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents du système nerveux central › Dépresseurs du système nerveux central › Stupéfiants › Analgésiques morphiniques › Concordance between high antibiotic...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Anti-infectieux › Antibactériens › Concordance between high antibiotic...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études transversales › Concordance between high antibiotic...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Concordance between high antibiotic...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Concordance between high antibiotic...
questionsmedicales.fr › Régions géographiques › Amériques › Amérique du Nord › Canada › Ontario › Concordance between high antibiotic...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Personnel de santé › Médecins › Médecins de premier recours › Concordance between high antibiotic...
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