Changes in the Appropriateness of US Outpatient Antibiotic Prescribing After the COVID-19 Outbreak: An Interrupted Time Series Analysis of 2016–2021 Data

Author:

Chua Kao-Ping12ORCID,Fischer Michael A3,Rahman Moshiur1,Linder Jeffrey A4

Affiliation:

1. Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School , Ann Arbor, MI , USA

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

3. Section of General Internal Medicine, Boston Medical Center, Boston University Chobanian and 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

Abstract

Abstract Background No national study has evaluated changes in the appropriateness of US outpatient antibiotic prescribing across all conditions and age groups after the coronavirus disease 2019 (COVID-19) outbreak in March 2020. Methods This was an interrupted time series analysis of Optum's de-identified Clinformatics Data Mart Database, a national commercial and Medicare Advantage claims database. Analyses included prescriptions for antibiotics dispensed to children and adults enrolled during each month during 2017–2021. For each prescription, we applied our previously developed antibiotic appropriateness classification scheme to International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes on medical claims occurring on or during the 3 days prior to dispensing. Outcomes included the monthly proportion of antibiotic prescriptions that were inappropriate and the monthly proportion of enrollees with ≥1 inappropriate prescription. Using segmented regression models, we assessed for level and slope changes in outcomes in March 2020. Results Analyses included 37 566 581 enrollees, of whom 19 154 059 (51.0%) were female. The proportion of enrollees with ≥1 inappropriate prescription decreased in March 2020 (level decrease: −0.80 percentage points [95% confidence interval {CI}, −1.09% to −.51%]) and subsequently increased (slope increase: 0.02 percentage points per month [95% CI, .01%–.03%]), partly because overall antibiotic dispensing rebounded and partly because the proportion of antibiotic prescriptions that were inappropriate increased (slope increase: 0.11 percentage points per month [95% CI, .04%–.18%]). In December 2021, the proportion of enrollees with ≥1 inappropriate prescription equaled the corresponding proportion in December 2019. Conclusions Despite an initial decline, the proportion of enrollees exposed to inappropriate antibiotics returned to baseline levels by December 2021. Findings underscore the continued importance of outpatient antibiotic stewardship initiatives.

Funder

National Institute on Drug Abuse

National Institute on Aging

Agency for Healthcare Research and Quality

National Institutes of Health

Publisher

Oxford University Press (OUP)

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