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Antibiotic prescribing without documented indication in ambulatory care clinics: national cross sectional study

OBJECTIVES: To identify the frequency with which antibiotics are prescribed in the absence of a documented indication in the ambulatory care setting, to quantify the potential effect on assessments of appropriateness of antibiotics, and to understand patient, provider, and visit level characteristic...

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Autores principales: Ray, Michael J, Tallman, Gregory B, Bearden, David T, Elman, Miriam R, McGregor, Jessina C
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group Ltd. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190070/
https://www.ncbi.nlm.nih.gov/pubmed/31826860
http://dx.doi.org/10.1136/bmj.l6461
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author Ray, Michael J
Tallman, Gregory B
Bearden, David T
Elman, Miriam R
McGregor, Jessina C
author_facet Ray, Michael J
Tallman, Gregory B
Bearden, David T
Elman, Miriam R
McGregor, Jessina C
author_sort Ray, Michael J
collection PubMed
description OBJECTIVES: To identify the frequency with which antibiotics are prescribed in the absence of a documented indication in the ambulatory care setting, to quantify the potential effect on assessments of appropriateness of antibiotics, and to understand patient, provider, and visit level characteristics associated with antibiotic prescribing without a documented indication. DESIGN: Cross sectional study. SETTING: 2015 National Ambulatory Medical Care Survey. PARTICIPANTS: 28 332 sample visits representing 990.9 million ambulatory care visits nationwide. MAIN OUTCOME MEASURES: Overall antibiotic prescribing and whether each antibiotic prescription was accompanied by appropriate, inappropriate, or no documented indication as identified through ICD-9-CM (international classification of diseases, 9th revision, clinical modification) codes. Survey weighted multivariable logistic regression was used to evaluate potential risk factors for receipt of an antibiotic prescription without a documented indication. RESULTS: Antibiotics were prescribed during 13.2% (95% confidence interval 11.6% to 13.7%) of the estimated 990.8 million ambulatory care visits in 2015. According to the criteria, 57% (52% to 62%) of the 130.5 million prescriptions were for appropriate indications, 25% (21% to 29%) were inappropriate, and 18% (15% to 22%) had no documented indication. This corresponds to an estimated 24 million prescriptions without a documented indication. Being an adult male, spending more time with the provider, and seeing a non-primary care specialist were significantly positively associated with antibiotic prescribing without an indication. Sulfonamides and urinary anti-infective agents were the antibiotic classes most likely to be prescribed without documentation. CONCLUSIONS: This nationally representative study of ambulatory visits identified a large number of prescriptions for antibiotics without a documented indication. Antibiotic prescribing in the absence of a documented indication may severely bias national estimates of appropriate antibiotic use in this setting. This study identified a wide range of factors associated with antibiotic prescribing without a documented indication, which may be useful in directing initiatives aimed at supporting better documentation.
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spelling pubmed-71900702020-05-01 Antibiotic prescribing without documented indication in ambulatory care clinics: national cross sectional study Ray, Michael J Tallman, Gregory B Bearden, David T Elman, Miriam R McGregor, Jessina C BMJ Research OBJECTIVES: To identify the frequency with which antibiotics are prescribed in the absence of a documented indication in the ambulatory care setting, to quantify the potential effect on assessments of appropriateness of antibiotics, and to understand patient, provider, and visit level characteristics associated with antibiotic prescribing without a documented indication. DESIGN: Cross sectional study. SETTING: 2015 National Ambulatory Medical Care Survey. PARTICIPANTS: 28 332 sample visits representing 990.9 million ambulatory care visits nationwide. MAIN OUTCOME MEASURES: Overall antibiotic prescribing and whether each antibiotic prescription was accompanied by appropriate, inappropriate, or no documented indication as identified through ICD-9-CM (international classification of diseases, 9th revision, clinical modification) codes. Survey weighted multivariable logistic regression was used to evaluate potential risk factors for receipt of an antibiotic prescription without a documented indication. RESULTS: Antibiotics were prescribed during 13.2% (95% confidence interval 11.6% to 13.7%) of the estimated 990.8 million ambulatory care visits in 2015. According to the criteria, 57% (52% to 62%) of the 130.5 million prescriptions were for appropriate indications, 25% (21% to 29%) were inappropriate, and 18% (15% to 22%) had no documented indication. This corresponds to an estimated 24 million prescriptions without a documented indication. Being an adult male, spending more time with the provider, and seeing a non-primary care specialist were significantly positively associated with antibiotic prescribing without an indication. Sulfonamides and urinary anti-infective agents were the antibiotic classes most likely to be prescribed without documentation. CONCLUSIONS: This nationally representative study of ambulatory visits identified a large number of prescriptions for antibiotics without a documented indication. Antibiotic prescribing in the absence of a documented indication may severely bias national estimates of appropriate antibiotic use in this setting. This study identified a wide range of factors associated with antibiotic prescribing without a documented indication, which may be useful in directing initiatives aimed at supporting better documentation. BMJ Publishing Group Ltd. 2019-12-11 /pmc/articles/PMC7190070/ /pubmed/31826860 http://dx.doi.org/10.1136/bmj.l6461 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Research
Ray, Michael J
Tallman, Gregory B
Bearden, David T
Elman, Miriam R
McGregor, Jessina C
Antibiotic prescribing without documented indication in ambulatory care clinics: national cross sectional study
title Antibiotic prescribing without documented indication in ambulatory care clinics: national cross sectional study
title_full Antibiotic prescribing without documented indication in ambulatory care clinics: national cross sectional study
title_fullStr Antibiotic prescribing without documented indication in ambulatory care clinics: national cross sectional study
title_full_unstemmed Antibiotic prescribing without documented indication in ambulatory care clinics: national cross sectional study
title_short Antibiotic prescribing without documented indication in ambulatory care clinics: national cross sectional study
title_sort antibiotic prescribing without documented indication in ambulatory care clinics: national cross sectional study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190070/
https://www.ncbi.nlm.nih.gov/pubmed/31826860
http://dx.doi.org/10.1136/bmj.l6461
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