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Physician antimicrobial prescribing and patient outcomes on general medical wards: a multicentre retrospective cohort study
BACKGROUND: Variability in antimicrobial prescribing may indicate an opportunity for improvement in antimicrobial use. We sought to measure physician-level antimicrobial prescribing in adult general medical wards, assess the contribution of patient-level factors to antimicrobial prescribing and eval...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
CMA Impact Inc.
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10442238/ https://www.ncbi.nlm.nih.gov/pubmed/37604522 http://dx.doi.org/10.1503/cmaj.221732 |
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author | McIntyre, Mark T. Saha, Sudipta Morris, Andrew M. Lapointe-Shaw, Lauren Tang, Terence Weinerman, Adina Fralick, Michael Agarwal, Arnav Verma, Amol Razak, Fahad |
author_facet | McIntyre, Mark T. Saha, Sudipta Morris, Andrew M. Lapointe-Shaw, Lauren Tang, Terence Weinerman, Adina Fralick, Michael Agarwal, Arnav Verma, Amol Razak, Fahad |
author_sort | McIntyre, Mark T. |
collection | PubMed |
description | BACKGROUND: Variability in antimicrobial prescribing may indicate an opportunity for improvement in antimicrobial use. We sought to measure physician-level antimicrobial prescribing in adult general medical wards, assess the contribution of patient-level factors to antimicrobial prescribing and evaluate the association between antimicrobial prescribing and clinical outcomes. METHODS: Using the General Medicine Inpatient Initiative (GEMINI) database, we conducted a retrospective cohort study of physician-level volume and spectrum of antimicrobial prescribing in adult general medical wards in 4 academic teaching hospitals in Toronto, Ontario, between April 2010 and December 2019. We stratified physicians into quartiles by hospital site based on volume of antimicrobial prescribing (days of therapy per 100 patient-days and antimicrobial-free days) and antibacterial spectrum (modified spectrum score). The modified spectrum score assigns a value to each antibacterial agent based on the breadth of coverage. We assessed patient-level differences among physician quartiles using age, sex, Laboratory-based Acute Physiology Score, discharge diagnosis and Charlson Comorbidity Index. We evaluated the association of clinical outcomes (in-hospital 30-day mortality, length of stay, intensive care unit [ICU] transfer and hospital readmission) with antimicrobial volume and spectrum using multilevel modelling. RESULTS: The cohort consisted of 124 physicians responsible for 124 158 hospital admissions. The median physician-level volume of antimicrobial prescribing was 56.1 (interquartile range 51.7–67.5) days of therapy per 100 patient-days. We did not find any differences in baseline patient characteristics by physician prescribing quartile. The difference in mean prescribing between quartile 4 and quartile 1 was 15.8 days of therapy per 100 patient-days (95% confidence interval [CI] 9.6–22.0), representing 30% higher antimicrobial prescribing in the fourth quartile than the first quartile. Patient in-hospital deaths, length of stay, ICU transfer and hospital readmission did not differ by physician quartile. In-hospital mortality was higher among patients cared for by prescribers with higher modified spectrum scores (odds ratio 1.13, 95% CI 1.04–1.24). INTERPRETATION: We found that physician-level variability in antimicrobial prescribing was not associated with differences in patient characteristics or outcomes in academic general medicine wards. These findings provide support for considering the lowest quartile of physician antimicrobial prescribing within each hospital as a target for antimicrobial stewardship. |
format | Online Article Text |
id | pubmed-10442238 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | CMA Impact Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-104422382023-08-23 Physician antimicrobial prescribing and patient outcomes on general medical wards: a multicentre retrospective cohort study McIntyre, Mark T. Saha, Sudipta Morris, Andrew M. Lapointe-Shaw, Lauren Tang, Terence Weinerman, Adina Fralick, Michael Agarwal, Arnav Verma, Amol Razak, Fahad CMAJ Research BACKGROUND: Variability in antimicrobial prescribing may indicate an opportunity for improvement in antimicrobial use. We sought to measure physician-level antimicrobial prescribing in adult general medical wards, assess the contribution of patient-level factors to antimicrobial prescribing and evaluate the association between antimicrobial prescribing and clinical outcomes. METHODS: Using the General Medicine Inpatient Initiative (GEMINI) database, we conducted a retrospective cohort study of physician-level volume and spectrum of antimicrobial prescribing in adult general medical wards in 4 academic teaching hospitals in Toronto, Ontario, between April 2010 and December 2019. We stratified physicians into quartiles by hospital site based on volume of antimicrobial prescribing (days of therapy per 100 patient-days and antimicrobial-free days) and antibacterial spectrum (modified spectrum score). The modified spectrum score assigns a value to each antibacterial agent based on the breadth of coverage. We assessed patient-level differences among physician quartiles using age, sex, Laboratory-based Acute Physiology Score, discharge diagnosis and Charlson Comorbidity Index. We evaluated the association of clinical outcomes (in-hospital 30-day mortality, length of stay, intensive care unit [ICU] transfer and hospital readmission) with antimicrobial volume and spectrum using multilevel modelling. RESULTS: The cohort consisted of 124 physicians responsible for 124 158 hospital admissions. The median physician-level volume of antimicrobial prescribing was 56.1 (interquartile range 51.7–67.5) days of therapy per 100 patient-days. We did not find any differences in baseline patient characteristics by physician prescribing quartile. The difference in mean prescribing between quartile 4 and quartile 1 was 15.8 days of therapy per 100 patient-days (95% confidence interval [CI] 9.6–22.0), representing 30% higher antimicrobial prescribing in the fourth quartile than the first quartile. Patient in-hospital deaths, length of stay, ICU transfer and hospital readmission did not differ by physician quartile. In-hospital mortality was higher among patients cared for by prescribers with higher modified spectrum scores (odds ratio 1.13, 95% CI 1.04–1.24). INTERPRETATION: We found that physician-level variability in antimicrobial prescribing was not associated with differences in patient characteristics or outcomes in academic general medicine wards. These findings provide support for considering the lowest quartile of physician antimicrobial prescribing within each hospital as a target for antimicrobial stewardship. CMA Impact Inc. 2023-08-21 2023-08-21 /pmc/articles/PMC10442238/ /pubmed/37604522 http://dx.doi.org/10.1503/cmaj.221732 Text en © 2023 CMA Impact Inc. or its licensors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/ |
spellingShingle | Research McIntyre, Mark T. Saha, Sudipta Morris, Andrew M. Lapointe-Shaw, Lauren Tang, Terence Weinerman, Adina Fralick, Michael Agarwal, Arnav Verma, Amol Razak, Fahad Physician antimicrobial prescribing and patient outcomes on general medical wards: a multicentre retrospective cohort study |
title | Physician antimicrobial prescribing and patient outcomes on general medical wards: a multicentre retrospective cohort study |
title_full | Physician antimicrobial prescribing and patient outcomes on general medical wards: a multicentre retrospective cohort study |
title_fullStr | Physician antimicrobial prescribing and patient outcomes on general medical wards: a multicentre retrospective cohort study |
title_full_unstemmed | Physician antimicrobial prescribing and patient outcomes on general medical wards: a multicentre retrospective cohort study |
title_short | Physician antimicrobial prescribing and patient outcomes on general medical wards: a multicentre retrospective cohort study |
title_sort | physician antimicrobial prescribing and patient outcomes on general medical wards: a multicentre retrospective cohort study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10442238/ https://www.ncbi.nlm.nih.gov/pubmed/37604522 http://dx.doi.org/10.1503/cmaj.221732 |
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