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

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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.

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Data Availability

Data was obtained from publicly available database administered by the Centers for Disease Control and Prevention. The R notebook script used to analyze this data is included in an electronic attachment.

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Funding

J. L. L. has a Resident Research Grant from the American Academy of Pediatrics, a Physician Investigator Award from Blue Cross Blue Shield Foundation of Michigan, and a Research Grant from the National Med-Peds Residents’ Association. K. C. is supported by a career development award from the National Institute on Drug Abuse (grant number 1K08DA048110-01). J. A. L. is supported by grants from the National Institute on Aging (P30AG059988, R01AG069762, R01AG074245, P30AG024968, R01AG070054, R33AG057395, R21AG081895), National Heart Lung and Blood Institute (R01HL167023), and the Agency for Healthcare Research and Quality (R01HS026506, R01HS028127, R01HS029328). The funding sources played no role in the design of the study; the collection, analysis, and interpretation of the data; and the decision to approve publication of the finished manuscript.

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Authors and Affiliations

  1. Departments of Internal Medicine and Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA

    Joseph B. Ladines-Lim MD, PhD

  2. Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA

    Joseph B. Ladines-Lim MD, PhD

  3. Section of General Internal Medicine, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA

    Michael A. Fischer MD, MS

  4. Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Jeffrey A. Linder MD, MPH

  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

    Kao-Ping Chua MD, PhD

  6. Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA

    Kao-Ping Chua MD, PhD

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  1. Joseph B. Ladines-Lim MD, PhD
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  2. Michael A. Fischer MD, MS
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  4. Kao-Ping Chua MD, PhD
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Contributions

Study concept and design: J. L. L., K. C. Acquisition of data: J. L. L., K. C. Analysis and interpretation of data: J. L. L., K. C., M. A. F., J. A. L. Drafting of the manuscript: J. L. L. Critical revision of the manuscript: J. L. L., K. C., M. A. F., J. A. L. Statistical analysis: J. L. L., K. C. Study supervision: K. C.

Corresponding author

Correspondence to Joseph B. Ladines-Lim MD, PhD.

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Conflict of Interest:

K. C. reports receiving honoraria from the Benter Foundation for work outside of the submitted manuscript. No other conflicts of interest were reported.

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Ladines-Lim, J., Fischer, M., Linder, J. et al. 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). https://doi.org/10.1007/s11606-024-08757-z

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