Almost one-fifth of antibiotic prescriptions written without documented reasons
Researchers from Oregon State University (OR, USA) have reviewed almost 30,000 outpatient visits to US healthcare providers during 2015 and determined that 18% of antibiotic prescriptions provided at these were written without documented reasons.
Researchers from Oregon State University (OR, USA) have analyzed 28,332 outpatient visits to US healthcare providers – excluding hospitals and other inpatient care facilities – during 2015 and determined that 18% of antibiotic prescriptions provided at these were written without documented reasons.
The study, recently published in the British Medical Journal, represents the first investigation into the proportion of antibiotic prescriptions written outside of inpatient healthcare services, such as hospitals, lacking documented ‘indications’ – accepted medical reasons for providing patients with the drug.
Lead study researcher Michael Ray (Oregon State University’s College of Pharmacy) commented: “Antibiotic prescribing without making note of the indication in a patient’s medical records might be leading to a significant underestimation of the scope of unnecessary prescribing. When there’s no indication documented, it’s reasonable to think that at least some of the time, the prescription was written without an appropriate indication present.”
Ray’s team employed data from the National Ambulatory Medical Care Survey for 2015; 28,332 outpatient visits to US healthcare providers, representing 990.8 million ambulatory visits nationwide, were identified and included in the study. Investigators assessed at what proportion of these visit antibiotics were prescribed, and the proportion of these prescriptions that were written without accompanying documented reasons.
The appropriateness of accompanying antibiotic prescription documentation was defined by the presence or absence of International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes in patients’ medical records.
Study analysis revealed that antibiotic prescriptions were written at 13.2% of the identified outpatient visits during 2015; of these, 57% were accompanied by appropriate documented indications.
However, 25% of antibiotic prescriptions were inappropriately indicated and a further 18% were not accompanied by documented indications at all.
Study collaborator Jessina McGregor (Oregon State University’s College of Pharmacy) concluded: “…that means…an estimated 24 million antibiotic prescriptions were written [nationwide] without a documented indication, on top of the 32 million that came with a documented but inappropriate indication.”
More detailed study analysis revealed that individuals were more likely to be prescribed antibiotics, without accompanying indication, if they spent more time than average with their healthcare provider, had chronic conditions or were seeing non-primary healthcare specialists.
Further, sulfonamides and urinary anti-infective drugs were the most common classes of antibiotics to be prescribed without accompanying written indications.
In the study, the authors concluded: “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.”
Ray MJ, Tallman GB, Bearden DT, Elman MR, McGregor JC. Antibiotic prescribing without documented indication in ambulatory care clinics: national cross sectional study. BMJ. doi:10.1136/bmj.l6461 (2019); (Epub ahead of print);