Chicago—As many as 20% of antibiotic prescriptions filled by pharmacists are provided without an in-person visit, a new conference presentation reveals.
The study, presented at IDWeek 2018, also points out that U.S. clinicians prescribed antibiotics without a bacterial infection-related diagnosis almost half the time.
The study, led by Northwestern University Feinberg School of Medicine researchers, is the first to look at overall outpatient antibiotic prescribing, analyzing more than half a million prescriptions from 514 outpatient clinics.
“We looked at all outpatient antibiotic prescribing and results suggest misuse of these drugs is a huge problem, no matter the symptom,” explained lead author Jeffrey A. Linder, MD, MPH. “We found that nearly half the time, clinicians have either a bad reason for prescribing antibiotics, or don’t provide a reason at all. When you consider about 80 percent of antibiotics are prescribed on an outpatient basis, that’s a concern.”
The study team sought to measure the prevalence of nonvisit–based and noninfection–related oral, antibacterial antibiotic prescribing between November 2015 and October 2017, using the electronic health record of an integrated health-delivery system.
The visit type—in-person versus other—was examined and classified into three mutually exclusive groups based on same-day diagnosis codes:
• Infection-related for prescriptions associated with at least one of 21,730 ICD-10 codes that may signify infection
• Noninfection-related for prescriptions only associated with the 72,519 ICD-10 codes that do not signify infections
• Associated with no diagnosis
Overall, the research looked at 509,534 antibiotic prescriptions issued to 279,169 unique patients by 2,413 clinicians in 514 clinics. Patients were a mean age of 43 years, 60% women and 75% white, while clinicians were 54% women.
Of the prescribers, 63% were attending physicians, 18% were residents/fellows, 10% were nurse practitioners, and 7% were physician assistants. Medical specialists made up 41% of the group, followed by 21% primary care clinicians and 7% surgical specialists.
Researchers report that the most common antibiotic classes were:
• Penicillins (30%)
• Macrolides (23%)
• Cephalosporins (14%)
• Fluoroquinolones (11%)
• Tetracyclines (10%)
• Sulfonamides (6%)
While 80% of the prescriptions were issued after an in-person visit, 20% of the antibiotic prescriptions were provided without seeing the patients—by telephone (10%), order-only (4%), refill (4%), and online portal (1%).
Nearly half, 46%, of antibiotics were prescribed without an infection-related diagnosis, according to the study team, who also note that 54% of antibiotic prescriptions were infection-related, 29% were noninfection-related, and 17% were associated with no diagnosis.
“Interventions that target visit-based, diagnosis-specific prescriptions miss a large share of antibiotic prescribing,” study authors conclude.
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The study, presented at IDWeek 2018, also points out that U.S. clinicians prescribed antibiotics without a bacterial infection-related diagnosis almost half the time.
The study, led by Northwestern University Feinberg School of Medicine researchers, is the first to look at overall outpatient antibiotic prescribing, analyzing more than half a million prescriptions from 514 outpatient clinics.
“We looked at all outpatient antibiotic prescribing and results suggest misuse of these drugs is a huge problem, no matter the symptom,” explained lead author Jeffrey A. Linder, MD, MPH. “We found that nearly half the time, clinicians have either a bad reason for prescribing antibiotics, or don’t provide a reason at all. When you consider about 80 percent of antibiotics are prescribed on an outpatient basis, that’s a concern.”
The study team sought to measure the prevalence of nonvisit–based and noninfection–related oral, antibacterial antibiotic prescribing between November 2015 and October 2017, using the electronic health record of an integrated health-delivery system.
The visit type—in-person versus other—was examined and classified into three mutually exclusive groups based on same-day diagnosis codes:
• Infection-related for prescriptions associated with at least one of 21,730 ICD-10 codes that may signify infection
• Noninfection-related for prescriptions only associated with the 72,519 ICD-10 codes that do not signify infections
• Associated with no diagnosis
Overall, the research looked at 509,534 antibiotic prescriptions issued to 279,169 unique patients by 2,413 clinicians in 514 clinics. Patients were a mean age of 43 years, 60% women and 75% white, while clinicians were 54% women.
Of the prescribers, 63% were attending physicians, 18% were residents/fellows, 10% were nurse practitioners, and 7% were physician assistants. Medical specialists made up 41% of the group, followed by 21% primary care clinicians and 7% surgical specialists.
Researchers report that the most common antibiotic classes were:
• Penicillins (30%)
• Macrolides (23%)
• Cephalosporins (14%)
• Fluoroquinolones (11%)
• Tetracyclines (10%)
• Sulfonamides (6%)
While 80% of the prescriptions were issued after an in-person visit, 20% of the antibiotic prescriptions were provided without seeing the patients—by telephone (10%), order-only (4%), refill (4%), and online portal (1%).
Nearly half, 46%, of antibiotics were prescribed without an infection-related diagnosis, according to the study team, who also note that 54% of antibiotic prescriptions were infection-related, 29% were noninfection-related, and 17% were associated with no diagnosis.
“Interventions that target visit-based, diagnosis-specific prescriptions miss a large share of antibiotic prescribing,” study authors conclude.
« Click here to return to Weekly News Update.
