What Drives Variation in Antibiotic Prescribing for Acute Respiratory Infections?

ABSTRACT:

Background

Acute respiratory infections are the most common symptomatic reason for seeking care among patients in the US, and account for the majority of all antibiotic prescribing, yet a large fraction of antibiotic prescriptions are inappropriate.

Objective

We sought to identify the underlying factors driving variation in antibiotic prescribing across clinicians and settings.

Design, participants

Using electronic health data for adult ambulatory visits for acute respiratory infections to a retail clinic chain and primary care practices from an integrated healthcare system, we identified a random sample of clinicians for survey.

Main measures

We evaluated independent predictors of overall prescribing and imperfect antibiotic prescribing, controlling for clinician and site of care. We defined imperfect antibiotic prescribing as prescribing for non-antibiotic-appropriate diagnoses, failure to prescribe for an antibiotic-appropriate diagnosis, or prescribing a non-guideline-concordant antibiotic.

Key results

Response rates were 34 % for retail clinics and 24 % for physicians' offices (N?=?187). Clinicians in physicians' offices prescribed antibiotics less often than those in retail clinics (53 % versus 67 %; p?ConclusionsPoor-quality antibiotic prescribing was associated with feeling rushed, believing less strongly that antibiotics were overused, and believing that patient demand was not an issue, factors that can be assessed and addressed in future interventions.

SUBMITTER: Gidengil CA 

PROVIDER: S-EPMC4945551 | biostudies-literature | 2016 Aug

REPOSITORIES: biostudies-literature