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. 2021 Dec 17;1(1):1-8.
doi: 10.1017/ash.2021.230.

Changes in outpatient antibiotic prescribing for acute respiratory illnesses, 2011 to 2018

Laura M King  1 , Sharon V Tsay  1 , Lauri A Hicks  1 , Destani Bizune  1 , Adam L Hersh  2 , Katherine Fleming-Dutra  1
Affiliations

Changes in outpatient antibiotic prescribing for acute respiratory illnesses, 2011 to 2018

Laura M King et al. Antimicrob Steward Healthc Epidemiol. .

Abstract

Objectives: To describe acute respiratory illnesses (ARI) visits and antibiotic prescriptions in 2011 and 2018 across outpatient settings to evaluate progress in reducing unnecessary antibiotic prescribing for ARIs.

Design: Cross-sectional study.

Setting and patients: Outpatient medical and pharmacy claims captured in the IBM MarketScan commercial database, a national convenience sample of privately insured individuals aged <65 years.

Methods: We calculated the annual number of ARI visits and visits with oral antibiotic prescriptions per 1,000 enrollees overall and by age category, sex, and setting in 2011 and 2018. We compared these and calculated prevalence rate ratios (PRRs). We adapted existing tiered-diagnosis methodology for International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes.

Results: In our study population, there were 829 ARI visits per 1,000 enrollees in 2011 compared with 760 ARI visits per 1,000 enrollees in 2018. In 2011, 39.3% of ARI visits were associated with ≥1 oral antibiotic prescription versus 36.2% in 2018. In 2018 compared with 2011, overall ARI visits decreased 8% (PRR, 0.92; 99.99% confidence interval [CI], 0.92-0.92), whereas visits with antibiotic prescriptions decreased 16% (PRR, 0.84; 99.99% CI, 0.84-0.85). Visits for antibiotic-inappropriate ARIs decreased by 9% (PRR, 0.91; 99.99% CI, 0.91-0.92), and visits with antibiotic prescriptions for these conditions decreased by 32% (PRR, 0.68; 99.99% CI, 0.67-0.68) from 2011 to 2018.

Conclusions: Both the rate of antibiotic prescriptions per 1,000 enrollees and the percentage of visits with antibiotic prescriptions decreased modestly from 2011 to 2018 in our study population. These decreases were greatest for antibiotic-inappropriate ARIs; however, additional reductions in inappropriate antibiotic prescribing are needed.

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Conflict of interest statement

Conflicts of interest. LMK was employed by Chenega Enterprise Systems and Solutions and assigned to the Centers for Disease Control and Prevention as part of a contract covering multiple tasks and positions. LMK has received consulting fees for unrelated work from Merck. All other authors report no conflicts related to this article.

Figures

Fig. 1.
Fig. 1.
Percentage of acute respiratory illness visits with antibiotic prescriptions by patient age group and antibiotic-indication tier, 2011 and 2018 MarketScan commercial dataset. Outpatient visits with associated oral antibiotic prescriptions by patient age group and antibiotic-indication tier, MarketScan commercial dataset, 2011 and 2018. MarketScan commercial dataset contain data on individuals aged <65 years. Calculated based on median age during MarketScan enrollment in each year.
Fig. 2.
Fig. 2.
Percent of acute respiratory illness (ARI) visits with associated antibiotic prescription by outpatient setting for (A) all ARIs, (B) ARIs for which antibiotics are almost always indicated, (C) ARIs for which antibiotics are sometimes indicated, (D) Antibiotic-inappropriate ARIs, 2011 and 2018 MarketScan commercial database. Outpatient visits with associated oral antibiotic prescriptions by outpatient setting and antibiotic-indication tier, MarketScan commercial dataset, 2011 and 2018. Other includes telehealth, schools, homeless shelters, Indian Health Services facilities, Tribal facilities, correctional facilities, patient homes, group homes, assisted living facilities, worksites, mobile healthcare units, birthing centers, military treatment facilities, custodial care facilities, hospice, adult living facilities, intermediate care facilities, psychiatric facilities, mental health centers, substance abuse facilities, rehabilitation facilities, dialysis facilities, ambulatory surgery centers, skilled nursing homes, long-term care facilities, inpatient hospital (outpatient services only) and outpatient not elsewhere classified.
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References

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