Prevalence of Inappropriate Antibiotic Prescribing with or without a Plausible Antibiotic Indication among Safety-Net and Non-Safety Net Populations

Joseph B Ladines-Lim; Michael A Fischer; Jeffrey A Linder; Kao-Ping Chua

doi:10.1007/s11606-024-08757-z

Prevalence of Inappropriate Antibiotic Prescribing with or without a Plausible Antibiotic Indication among Safety-Net and Non-Safety Net Populations

J Gen Intern Med. 2024 Apr 26. doi: 10.1007/s11606-024-08757-z. Online ahead of print.

Authors

Joseph B Ladines-Lim^{1

2}, Michael A Fischer³, Jeffrey A Linder⁴, Kao-Ping Chua^{5

6}

Affiliations

¹ Departments of Internal Medicine and Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA. ladinesl@med.umich.edu.
² Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA. ladinesl@med.umich.edu.
³ Section of General Internal Medicine, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
⁴ Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
⁵ Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan Medical School, University of Michigan School of Public Health, Ann Arbor, MI, USA.
⁶ Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA.

PMID: 38671203
DOI: 10.1007/s11606-024-08757-z

Abstract

Background: Clinicians can prescribe antibiotics inappropriately without coding the indication for antibiotics. Whether the prevalence of inappropriate antibiotic prescribing with or without a plausible indication differs between safety-net and non-safety-net populations is unknown.

Objective: To assess differences in inappropriate antibiotic prescribing with or without a plausible indication between safety-net and non-safety net populations.

Design: Cross-sectional.

Participants: Office visits in the 2016, 2018, 2019 National Ambulatory Medical Care Survey with ≥ 1 antibiotic prescription among children (0-17 years) and adults (18-64 years).

Main measures: Inappropriate antibiotic prescribing with a plausible indication (visits with infection-related diagnosis codes that do not warrant antibiotics, e.g., acute bronchitis); inappropriate prescribing without a plausible indication (visits with codes that are not antibiotic indications, e.g., hypertension). By age group, we used linear regression to assess differences between safety-net (public/no insurance) and non-safety net populations (privately insured), controlling for patient and visit characteristics.

Key results: Analyses included 67,065,108 and 122,731,809 weighted visits for children and adults, respectively. Among visits for children in the safety-net and non-safety populations, the prevalence of inappropriate antibiotic prescribing with a plausible indication was 11.7% and 22.0% (adjusted difference: -8.0%, 95% CI: -17.1%, 1.0%); the prevalence of inappropriate prescribing without a plausible indication was 11.8% and 8.6% (adjusted difference: -2.0%, 95% CI: -4.6%, 0.6%). Among visits for adults in the safety-net and non-safety populations, the prevalence of inappropriate antibiotic prescribing with a plausible indication was 12.1% and 14.3% (adjusted difference: -0.1%, 95% CI -9.4%, 9.1%); the prevalence of inappropriate prescribing without a plausible indication was 48.2% and 32.3% (adjusted difference: 12.5%, 95% CI: 3.6%, 21.4%).

Conclusions: Inappropriate antibiotic prescribing with or without a plausible antibiotic indication is common in all populations, highlighting the importance of broad-based antibiotic stewardship initiatives. However, targeted initiatives focused on improving coding quality in adult safety-net settings may be warranted.

Grants and funding

K08 DA048110/DA/NIDA NIH HHS/United States