Risk Factors for Unnecessary Antibiotic Prescribing for Acute Respiratory Tract Infections in Primary Care

Objective: To determine independent risk factors for inappropriate antibiotic prescribing for acute respiratory tract infections (ARIs) in internal medicine (IM) residency–based primary care offices. Patients and Methods: A retrospective study was conducted to measure antibiotic prescribing rates, a...

Full description

Bibliographic Details
Main Authors: Thomas L. Walsh, MD, Kevin Taffe, MD, PhD, Nicole Sacca, DO, Derek N. Bremmer, PharmD, BCPS, Mary Lynn Sealey, MD, Elizabeth Cuevas, MD, Alexandra Johnston, DO, Alyson Malarkey, DO, Rebecca Behr, DO, Jessica Embrescia, DO, Ekknoor Sahota, MD, Sara Loucks, DO, Nupur Gupta, DO, Kelly J. Shields, PhD, Curren Katz, PhD, Anastasios Kapetanos, MD
Format: Article
Language:English
Published: Elsevier 2020-02-01
Series:Mayo Clinic Proceedings: Innovations, Quality & Outcomes
Online Access:http://www.sciencedirect.com/science/article/pii/S2542454819301481
_version_ 1818175076128784384
author Thomas L. Walsh, MD
Kevin Taffe, MD, PhD
Nicole Sacca, DO
Derek N. Bremmer, PharmD, BCPS
Mary Lynn Sealey, MD
Elizabeth Cuevas, MD
Alexandra Johnston, DO
Alyson Malarkey, DO
Rebecca Behr, DO
Jessica Embrescia, DO
Ekknoor Sahota, MD
Sara Loucks, DO
Nupur Gupta, DO
Kelly J. Shields, PhD
Curren Katz, PhD
Anastasios Kapetanos, MD
author_facet Thomas L. Walsh, MD
Kevin Taffe, MD, PhD
Nicole Sacca, DO
Derek N. Bremmer, PharmD, BCPS
Mary Lynn Sealey, MD
Elizabeth Cuevas, MD
Alexandra Johnston, DO
Alyson Malarkey, DO
Rebecca Behr, DO
Jessica Embrescia, DO
Ekknoor Sahota, MD
Sara Loucks, DO
Nupur Gupta, DO
Kelly J. Shields, PhD
Curren Katz, PhD
Anastasios Kapetanos, MD
author_sort Thomas L. Walsh, MD
collection DOAJ
description Objective: To determine independent risk factors for inappropriate antibiotic prescribing for acute respiratory tract infections (ARIs) in internal medicine (IM) residency–based primary care offices. Patients and Methods: A retrospective study was conducted to measure antibiotic prescribing rates, and multivariable analysis was utilized to identify predictors of inappropriate prescribing among patients presenting to IM residency–based primary care office practices. Patients with an office visit at either of 2 IM residency–based primary care office practices from January 1, 2016, through December 31, 2016, with a primary encounter diagnosis of ARI were included. Results: During the study period, 911 unique patient encounters were included with 518 for conditions for which antibiotics were considered always inappropriate. Antibiotics were not indicated in 85.8% (782 of 911) of encounters. However, antibiotics were prescribed in 28.4% (222 of 782) of these encounters. Inappropriate antibiotic prescribing occurred in 111 of 518 (21.4%) encounters for conditions for which antibiotics are always inappropriate. Using multivariable logistic regression analysis to assess for independent risk factors when adjusted for other potential risk factors for office visits at which antibiotics were not indicated, IM resident–associated visits (odds ratio, 0.25; 95% CI, 0.18-0.36) was the only variable independently associated with lower risk of inappropriate antibiotic prescribing. Conclusion: For ARI visits at which antibiotics were not indicated, IM resident comanagement was associated with lower rates of inappropriate prescribing.
first_indexed 2024-12-11T19:54:32Z
format Article
id doaj.art-3ab67e232b32488ab0b9c0a83c3cae36
institution Directory Open Access Journal
issn 2542-4548
language English
last_indexed 2024-12-11T19:54:32Z
publishDate 2020-02-01
publisher Elsevier
record_format Article
series Mayo Clinic Proceedings: Innovations, Quality & Outcomes
spelling doaj.art-3ab67e232b32488ab0b9c0a83c3cae362022-12-22T00:52:40ZengElsevierMayo Clinic Proceedings: Innovations, Quality & Outcomes2542-45482020-02-01413139Risk Factors for Unnecessary Antibiotic Prescribing for Acute Respiratory Tract Infections in Primary CareThomas L. Walsh, MD0Kevin Taffe, MD, PhD1Nicole Sacca, DO2Derek N. Bremmer, PharmD, BCPS3Mary Lynn Sealey, MD4Elizabeth Cuevas, MD5Alexandra Johnston, DO6Alyson Malarkey, DO7Rebecca Behr, DO8Jessica Embrescia, DO9Ekknoor Sahota, MD10Sara Loucks, DO11Nupur Gupta, DO12Kelly J. Shields, PhD13Curren Katz, PhD14Anastasios Kapetanos, MD15Department of Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA; Division of Infectious Diseases, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA; Department of Medicine and Division of Infectious Diseases, Western Pennsylvania Hospital, Allegheny Health Network, Pittsburgh; Correspondence: Address to Thomas L. Walsh, MD, Allegheny General Hospital, 320 E North Ave, 4th Floor East Wing, Ste 406, Pittsburgh, PA 15212.Department of Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PADepartment of Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PADepartment of Pharmacy, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PADepartment of Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PADepartment of Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PADepartment of Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PADepartment of Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PADepartment of Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PADepartment of Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PADepartment of Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PADepartment of Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PADepartment of Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PAData Science R&D, Highmark Health, Pittsburgh, PAData Science R&D, Highmark Health, Pittsburgh, PADepartment of Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PAObjective: To determine independent risk factors for inappropriate antibiotic prescribing for acute respiratory tract infections (ARIs) in internal medicine (IM) residency–based primary care offices. Patients and Methods: A retrospective study was conducted to measure antibiotic prescribing rates, and multivariable analysis was utilized to identify predictors of inappropriate prescribing among patients presenting to IM residency–based primary care office practices. Patients with an office visit at either of 2 IM residency–based primary care office practices from January 1, 2016, through December 31, 2016, with a primary encounter diagnosis of ARI were included. Results: During the study period, 911 unique patient encounters were included with 518 for conditions for which antibiotics were considered always inappropriate. Antibiotics were not indicated in 85.8% (782 of 911) of encounters. However, antibiotics were prescribed in 28.4% (222 of 782) of these encounters. Inappropriate antibiotic prescribing occurred in 111 of 518 (21.4%) encounters for conditions for which antibiotics are always inappropriate. Using multivariable logistic regression analysis to assess for independent risk factors when adjusted for other potential risk factors for office visits at which antibiotics were not indicated, IM resident–associated visits (odds ratio, 0.25; 95% CI, 0.18-0.36) was the only variable independently associated with lower risk of inappropriate antibiotic prescribing. Conclusion: For ARI visits at which antibiotics were not indicated, IM resident comanagement was associated with lower rates of inappropriate prescribing.http://www.sciencedirect.com/science/article/pii/S2542454819301481
spellingShingle Thomas L. Walsh, MD
Kevin Taffe, MD, PhD
Nicole Sacca, DO
Derek N. Bremmer, PharmD, BCPS
Mary Lynn Sealey, MD
Elizabeth Cuevas, MD
Alexandra Johnston, DO
Alyson Malarkey, DO
Rebecca Behr, DO
Jessica Embrescia, DO
Ekknoor Sahota, MD
Sara Loucks, DO
Nupur Gupta, DO
Kelly J. Shields, PhD
Curren Katz, PhD
Anastasios Kapetanos, MD
Risk Factors for Unnecessary Antibiotic Prescribing for Acute Respiratory Tract Infections in Primary Care
Mayo Clinic Proceedings: Innovations, Quality & Outcomes
title Risk Factors for Unnecessary Antibiotic Prescribing for Acute Respiratory Tract Infections in Primary Care
title_full Risk Factors for Unnecessary Antibiotic Prescribing for Acute Respiratory Tract Infections in Primary Care
title_fullStr Risk Factors for Unnecessary Antibiotic Prescribing for Acute Respiratory Tract Infections in Primary Care
title_full_unstemmed Risk Factors for Unnecessary Antibiotic Prescribing for Acute Respiratory Tract Infections in Primary Care
title_short Risk Factors for Unnecessary Antibiotic Prescribing for Acute Respiratory Tract Infections in Primary Care
title_sort risk factors for unnecessary antibiotic prescribing for acute respiratory tract infections in primary care
url http://www.sciencedirect.com/science/article/pii/S2542454819301481
work_keys_str_mv AT thomaslwalshmd riskfactorsforunnecessaryantibioticprescribingforacuterespiratorytractinfectionsinprimarycare
AT kevintaffemdphd riskfactorsforunnecessaryantibioticprescribingforacuterespiratorytractinfectionsinprimarycare
AT nicolesaccado riskfactorsforunnecessaryantibioticprescribingforacuterespiratorytractinfectionsinprimarycare
AT dereknbremmerpharmdbcps riskfactorsforunnecessaryantibioticprescribingforacuterespiratorytractinfectionsinprimarycare
AT marylynnsealeymd riskfactorsforunnecessaryantibioticprescribingforacuterespiratorytractinfectionsinprimarycare
AT elizabethcuevasmd riskfactorsforunnecessaryantibioticprescribingforacuterespiratorytractinfectionsinprimarycare
AT alexandrajohnstondo riskfactorsforunnecessaryantibioticprescribingforacuterespiratorytractinfectionsinprimarycare
AT alysonmalarkeydo riskfactorsforunnecessaryantibioticprescribingforacuterespiratorytractinfectionsinprimarycare
AT rebeccabehrdo riskfactorsforunnecessaryantibioticprescribingforacuterespiratorytractinfectionsinprimarycare
AT jessicaembresciado riskfactorsforunnecessaryantibioticprescribingforacuterespiratorytractinfectionsinprimarycare
AT ekknoorsahotamd riskfactorsforunnecessaryantibioticprescribingforacuterespiratorytractinfectionsinprimarycare
AT saraloucksdo riskfactorsforunnecessaryantibioticprescribingforacuterespiratorytractinfectionsinprimarycare
AT nupurguptado riskfactorsforunnecessaryantibioticprescribingforacuterespiratorytractinfectionsinprimarycare
AT kellyjshieldsphd riskfactorsforunnecessaryantibioticprescribingforacuterespiratorytractinfectionsinprimarycare
AT currenkatzphd riskfactorsforunnecessaryantibioticprescribingforacuterespiratorytractinfectionsinprimarycare
AT anastasioskapetanosmd riskfactorsforunnecessaryantibioticprescribingforacuterespiratorytractinfectionsinprimarycare