Abiy Agiro1, Santosh Gautam1, Eric Wall2, Jesse Hackell3, Mark Helm4, John Barron5, Theoklis Zaoutis6, Katherine E Fleming-Dutra7, Lauri A Hicks7, Alan Rosenberg8. 1. From the Translational Research for Affordability and Quality, HealthCore, Inc, Wilmington, Delaware. 2. Department of Family Medicine, University of Washington, Seattle, Washington. 3. Pomona Pediatrics, Children's and Women's Physicians of Westchester, Pomona, New York. 4. General Pediatrics, Childhood Health Associates of Salem, Salem, Oregon. 5. HealthCore, Inc, Wilmington, Delaware. 6. Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 7. Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. 8. Medical and Clinical Pharmacy Policy, Anthem, Inc, Chicago, Illinois.
Abstract
BACKGROUND: Antibiotics are commonly prescribed for children with acute respiratory infections (ARIs). This study describes the distribution of ARI diagnoses and specifically quantifies antibiotic dispensing for bronchitis and upper respiratory infection (URI) by treatment setting and specialty. METHODS: This retrospective, observational cross-sectional study used data from the HealthCore Integrated Research Environment containing claims from 14 commercial health plans for 2012 to 2014. Children (2-17 years) with first-episode ARI were identified by diagnosis of acute otitis media (AOM), sinusitis, pharyngitis, bronchitis or URI with no competing infections or chronic illnesses. Treatment setting was where diagnoses were made: primary care offices, urgent care centers (UCC), retail health clinics (RHCs) or emergency departments. Primary outcome measure was antibiotic prescription fills from pharmacies within 2 days of start of ARI episode. RESULTS: For URI, the highest proportions in antibiotic dispensing were ordered by office-based or UCC family physicians (28% and 30%, respectively) and office-based or UCC nurse practitioners/physician assistants (30% and 29%, respectively). Across all settings and specialties, there was high proportion of antibiotic dispensing for bronchitis (75%). Overall, 48% of 544,531 children diagnosed with ARI filled antibiotics. Nurse practitioners/physician assistants in RHC made the most diagnoses of AOM (24%) and streptococcal pharyngitis (22%). CONCLUSIONS: Outreach efforts to decrease antibiotic dispensing for URI can be focused on office-based and UCC family physicians and nurse practitioners/physician assistants. All specialties need widespread interventions to reduce antibiotic dispensing for bronchitis. RHC nurse practitioners/physician assistants can be targeted to reduce high proportion of AOM and streptococcal pharyngitis diagnoses.
BACKGROUND: Antibiotics are commonly prescribed for children with acute respiratory infections (ARIs). This study describes the distribution of ARI diagnoses and specifically quantifies antibiotic dispensing for bronchitis and upper respiratory infection (URI) by treatment setting and specialty. METHODS: This retrospective, observational cross-sectional study used data from the HealthCore Integrated Research Environment containing claims from 14 commercial health plans for 2012 to 2014. Children (2-17 years) with first-episode ARI were identified by diagnosis of acute otitis media (AOM), sinusitis, pharyngitis, bronchitis or URI with no competing infections or chronic illnesses. Treatment setting was where diagnoses were made: primary care offices, urgent care centers (UCC), retail health clinics (RHCs) or emergency departments. Primary outcome measure was antibiotic prescription fills from pharmacies within 2 days of start of ARI episode. RESULTS: For URI, the highest proportions in antibiotic dispensing were ordered by office-based or UCC family physicians (28% and 30%, respectively) and office-based or UCC nurse practitioners/physician assistants (30% and 29%, respectively). Across all settings and specialties, there was high proportion of antibiotic dispensing for bronchitis (75%). Overall, 48% of 544,531 children diagnosed with ARI filled antibiotics. Nurse practitioners/physician assistants in RHC made the most diagnoses of AOM (24%) and streptococcal pharyngitis (22%). CONCLUSIONS: Outreach efforts to decrease antibiotic dispensing for URI can be focused on office-based and UCC family physicians and nurse practitioners/physician assistants. All specialties need widespread interventions to reduce antibiotic dispensing for bronchitis. RHC nurse practitioners/physician assistants can be targeted to reduce high proportion of AOM and streptococcal pharyngitis diagnoses.
Authors: Holly M Frost; Lauren F Becker; Bryan C Knepper; Katherine C Shihadeh; Timothy C Jenkins Journal: J Pediatr Date: 2020-02-25 Impact factor: 4.406
Authors: Adam L Hersh; Laura M King; Daniel J Shapiro; Lauri A Hicks; Katherine E Fleming-Dutra Journal: Clin Infect Dis Date: 2021-01-23 Impact factor: 20.999
Authors: Daniel J Shapiro; Laura M King; Katherine E Fleming-Dutra; Lauri A Hicks; Adam L Hersh Journal: Infect Control Hosp Epidemiol Date: 2020-02-24 Impact factor: 6.520
Authors: Rachel L Snyder; Laura M King; Adam L Hersh; Katherine E Fleming-Dutra Journal: Infect Control Hosp Epidemiol Date: 2020-10-16 Impact factor: 3.254