Patient and provider characteristics and outcomes associated with outpatient antibiotic overuse in acute adult bronchitis

Diana Li; Maricar Conson; Nina Kim; Marie Yasuda; Delaney Ivy; Sandy Diec; Paul Godley

doi:10.1080/08998280.2019.1708667

Patient and provider characteristics and outcomes associated with outpatient antibiotic overuse in acute adult bronchitis

Proc (Bayl Univ Med Cent). 2020 Feb 3;33(2):183-187. doi: 10.1080/08998280.2019.1708667. eCollection 2020 Apr.

Authors

Diana Li¹, Maricar Conson¹, Nina Kim², Marie Yasuda², Delaney Ivy³, Sandy Diec³, Paul Godley^{1

2}

Affiliations

¹ Department of Outpatient Pharmacy, Baylor Health EnterprisesTempleTexas.
² Department of Health Outcomes, The University of Texas College of PharmacyAustinTexas.
³ Department of Pharmacy Practice, Texas A&M University Irma Lerma Rangel College of PharmacyKingsvilleTexas.

Abstract

Nonbacterial acute bronchitis leads to many outpatient clinic visits in the US that result in an antibiotic prescription. Understanding antibiotic prescribing patterns and their clinical consequences will help improve antimicrobial stewardship efforts. A retrospective chart review was conducted to identify any correlations between patient and provider characteristics with antibiotic use in adult acute bronchitis (AAB) and to compare the clinical outcomes and rates of health care utilization between those who did and did not receive antibiotics. Study participants included adults with uncomplicated AAB seen by family medicine or internal medicine, specialty, and mid-level practitioners in a Baylor Scott & White Health outpatient facility. Phase 1 investigated whether prescribing rates varied by provider- or patient-level characteristics. Phase 2 compared clinical outcomes and health care utilization between patients who received an antibiotic versus those who did not receive an antibiotic for AAB. Among 35,383 visits for AAB, 81.4% resulted in a prescription for an antibiotic. Physicians >35 years of age and internal and family medicine physicians were more likely to prescribe antibiotics. Health care utilization rates did not differ between cohorts. The number of Clostridium difficile events was negligible.

Keywords: Acute bronchitis; community-acquired Clostridium difficile; health care utilization; outpatient antibiotics; upper respiratory tract infection.