Abstract
AbstractObjectivesTo 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.DesignCross sectional study.Setting2015 National Ambulatory Medical Care Survey.Participants28 332 sample visits representing 990.9 million ambulatory care visits
nationwide.Main outcome measuresOverall 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.ResultsAntibiotics 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.ConclusionsThis 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.
Cited by
45 articles.
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