Antibiotic Prescribing Patterns for Urinary Tract Infections and Pneumonia by Prescriber Type and Specialty in Nursing Home Care, 2016-2018

Abstract

Objective: To identify whether differences in antibiotic prescribing practices by prescriber type and specialization in nursing home (NH) care exist for urinary tract infection (UTI) and pneumonia.

Design: Retrospective cohort.

Setting and participants: This national study included antibiotic dispensings to traditional Medicare beneficiaries aged ≥65 years with UTI or pneumonia infections residing long-term (≥100 days) in US NHs between 2016 and 2018.

Methods: Minimum Data Set assessment data were linked to Medicare data [Part D prescription drug, inpatient hospital (MedPAR), prescriber characteristics, and enrollment]. We compared antibiotic prescribing patterns by prescriber type [physician vs advanced practice practitioner (AP)] and NH specialization (≥90% vs <90% of all associated medication dispensings to NH residents). Antibiotic dispensing measures included the total number of dispensings and duration of therapy (median number of days supplied) by antibiotic class.

Results: There were 264,735 antibiotic dispensings prescribed by 32,437 prescribers for 140,360 residents in 14,035 NHs. NH specialists were less likely to prescribe fluoroquinolones for UTI (22.9% NH specialist physician, 23.9% non-NH specialist physician, 21.3% NH specialist AP, 24.2% non-NH specialist AP), but more likely to prescribe fluoroquinolones for pneumonia (38.9%, 37.8%, 38.8%, 37.3%, respectively). Over time, NH specialists reduced fluoroquinolone prescribing for pneumonia to a greater extent than non-NH specialists. The duration of therapy was similar across prescriber groups for UTI, but longer among non-NH specialist APs for several antibiotic classes for pneumonia, including tetracyclines, glycopeptides and lipoglycopeptides, and metronidazole.

Conclusions and implications: There were differences in antibiotic prescribing patterns by prescriber type and specialization in NH care between 2016 and 2018. Understanding how antibiotic prescribing differs based on prescriber characteristics is essential to inform antibiotic stewardship efforts. Tailoring antibiotic stewardship efforts to prescribers by NH specialization is rational given differences in antibiotic prescribing patterns based on NH specialization.

Keywords: Antimicrobial stewardship; antibacterial agents; long-term care; nursing homes; physicians; practice patterns; urinary tract infections.

Figure 1.. Antibiotic Classes Prescribed to Long-Stay Nursing Home Residents with UTI, by Prescriber Group, 2016–2018. (N=214,759 dispensings)

Abbreviations: NH, Nursing Home. Note: Nursing home specialists were defined as prescribers for whom ≥ 90% of all dispensings (not only antibiotics) attributed to their National Provider Identifier were for nursing home residents. Nursing home specialization was reassessed yearly. Antibiotics with low frequencies were categorized as “other antibiotics.” Individual antibiotics included in each class are listed in Supplementary Table 1.

Figure 2.. Antibiotic Classes Prescribed to Long-Stay Nursing Home Residents with Pneumonia, by Prescriber Group, 2016–2018. (N=49,976 dispensings)

Abbreviations: NH, Nursing Home. Note: Nursing home specialists were defined as prescribers for whom ≥ 90% of all dispensings (not only antibiotics) attributed to their National Provider Identifier were for nursing home residents. Nursing home specialization was reassessed yearly. Antibiotics with low frequencies were categorized as “other antibiotics.” Individual antibiotics included in each class are listed in Supplementary Table 1.