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February 18, 2015
Some Medical Practices More Likely to Inappropriately Prescribe Antibiotics
Boston—Nearly half of all patients with respiratory tract infections (RTIs) were inappropriately prescribed antibiotics in an inner-city academic medical center during a 2-year period, a new study has found. The study, led by researchers from Boston University and published recently in Infection Control & Hospital Epidemiology, looked at general internal medicine and family medicine practices at Boston Medical Center from 2008 to 2010. During that time period, 4,942 visits were recorded. Background information in the article notes that, especially In the ambulatory care setting, antibiotics are often prescribed inappropriately for conditions such as bronchitis, acute pharyngitis, and upper RTI, even though those conditions do not require antibiotic interventions. Overuse raises healthcare costs and increases the risk of development of antibiotic-resistant bacteria, the report notes. “Physicians’ inappropriate prescribing patterns appeared to differ by medical specialty and to be established early, likely during medical school or residency,” said lead author Tamar Barlam, MD, director of the Antimicrobial Stewardship Program for Boston Medical Center and associate professor of medicine at Boston University School of Medicine. “Instituting aggressive interventions in training or practice at the right time and to the right physicians could improve antibiotic use and efficacy of antibiotic stewardship in outpatient settings.” Inappropriate prescribing was significantly associated with family medicine providers, female gender and self-reported race/ethnicity as white or Hispanic, according to the results. The retrospective review found that physicians in the lowest quartile prescribed antibiotics for 5% to 28% of patients with RTIs, but that physicians in the highest quartile prescribed antibiotics 54% to 85% of the time. Overall, the researchers found, high prescribers had fewer African-American patients and more patients who were younger and privately insured. Chronic lung disease also was more common among patients of high prescribers. The effect was not limited to single physicians in a practice, however. A general internal medicine practice group with a low prescriber was 3.0 times more likely to have a second low prescriber, compared to other practice pods, while those with one high prescriber were 1.3 times more likely to have a second, the study found. The highest amount of inappropriate antibiotic use was found with bronchitis, where 71% of patients received an antibiotic, followed by sore throat at 50% and nonspecific RTI at 28%. Overall, women were found to be prescribed antibiotics more frequently than men, and black patients were less likely to be overprescribed the medications than white patients. “It is concerning that there may be a different approach to patients depending on race or gender, which may suggest inequities in care,” Barlam said. Study authors call for comprehensive education about antimicrobials and stewardship in medical school curricula to prevent establishment of poor prescribing practices. They also suggest enlisting low prescribers to help influence efficient use of resources.
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