Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011.
Adolescence; Adolescent; Adult; Aged; Ambulatory Care – Statistics and Numerical Data; Ambulatory Care/*statistics & numerical data; Anti-Bacterial Agents/*therapeutic use; Antibiotics – Therapeutic Use; Child; Female; Health Care Surveys; Human; Humans; Inappropriate Prescribing – Statistics and Numerical Data; Inappropriate Prescribing/*statistics & numerical data; Infant; Male; Middle Age; Middle Aged; Newborn; Otitis Media; Otitis Media – Drug Therapy; Pharyngitis – Drug Therapy; Pharyngitis/drug therapy; Physicians'/*statistics & numerical data; Practice Patterns; Preschool; Prevalence; Respiratory Tract Infections – Drug Therapy; Respiratory Tract Infections/drug therapy; Suppurative/*drug therapy; Surveys; United States
IMPORTANCE: The National Action Plan for Combating Antibiotic-Resistant Bacteria set a goal of reducing inappropriate outpatient antibiotic use by 50% by 2020, but the extent of inappropriate outpatient antibiotic use is unknown. OBJECTIVE: To estimate the rates of outpatient oral antibiotic prescribing by age and diagnosis, and the estimated portions of antibiotic use that may be inappropriate in adults and children in the United States. DESIGN, SETTING, AND PARTICIPANTS: Using the 2010-2011 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, annual numbers and population-adjusted rates with 95% confidence intervals of ambulatory visits with oral antibiotic prescriptions by age, region, and diagnosis in the United States were estimated. EXPOSURES: Ambulatory care visits. MAIN OUTCOMES AND MEASURES: Based on national guidelines and regional variation in prescribing, diagnosis-specific prevalence and rates of total and appropriate antibiotic prescriptions were determined. These rates were combined to calculate an estimate of the appropriate annual rate of antibiotic prescriptions per 1000 population. RESULTS: Of the 184,032 sampled visits, 12.6% of visits (95% CI, 12.0%-13.3%) resulted in antibiotic prescriptions. Sinusitis was the single diagnosis associated with the most antibiotic prescriptions per 1000 population (56 antibiotic prescriptions [95% CI, 48-64]), followed by suppurative otitis media (47 antibiotic prescriptions [95% CI, 41-54]), and pharyngitis (43 antibiotic prescriptions [95% CI, 38-49]). Collectively, acute respiratory conditions per 1000 population led to 221 antibiotic prescriptions (95% CI, 198-245) annually, but only 111 antibiotic prescriptions were estimated to be appropriate for these conditions. Per 1000 population, among all conditions and ages combined in 2010-2011, an estimated 506 antibiotic prescriptions (95% CI, 458-554) were written annually, and, of these, 353 antibiotic prescriptions were estimated to be appropriate antibiotic prescriptions. CONCLUSIONS AND RELEVANCE: In the United States in 2010-2011, there was an estimated annual antibiotic prescription rate per 1000 population of 506, but only an estimated 353 antibiotic prescriptions were likely appropriate, supporting the need for establishing a goal for outpatient antibiotic stewardship.
Fleming-Dutra Katherine E; Hersh Adam L; Shapiro Daniel J; Bartoces Monina; Enns Eva A; File Thomas M Jr; Finkelstein Jonathan A; Gerber Jeffrey S; Hyun David Y; Linder Jeffrey A; Lynfield Ruth; Margolis David J; May Larissa S; Merenstein Daniel; Metlay Joshua P; Newland Jason G; Piccirillo Jay F; Roberts Rebecca M; Sanchez Guillermo V; Suda Katie J; Thomas Ann; Woo Teri Moser; Zetts Rachel M; Hicks Lauri A
JAMA
2016
2016-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1001/jama.2016.4151" target="_blank" rel="noreferrer noopener">10.1001/jama.2016.4151</a>
A comparison of the National Ambulatory Medical Care Survey (NAMCS) measurement approach with direct observation of outpatient visits.
80 and over; Adolescent; Adult; Aged; Ambulatory Care/*statistics & numerical data; Bias; Child; Family Practice/*statistics & numerical data; Female; Health Care Surveys/*methods/standards; Humans; Infant; Male; Middle Aged; Observation/*methods; Office Visits/*statistics & numerical data; Ohio; Preschool; Research Design/standards; Sensitivity and Specificity; Time Factors
BACKGROUND: The National Ambulatory Medical Care Survey (NAMCS) informs a wide range of important policy and clinical decisions by providing nationally representative data about outpatient practice. However, the validity of the NAMCS methods has not been compared with a reference standard. METHODS: Office visits of 549 patients visiting 30 family physicians in Northeastern Ohio were observed by trained research nurses. Visit content measured by direct observation was compared with data reported by physicians using the 1993 NAMCS form. RESULTS: Outpatient visit physician reports of procedures and examinations using the NAMCS method showed generally good concordance with direct observation measures, with kappas ranging from 0.39 for ordering a chest x-ray to 0.86 for performance of Pap smears. Concordance was generally lower for health behavior counseling, with kappas ranging from 0.21 for alcohol counseling to 0.60 for smoking cessation advice. The NAMCS form had high specificity (range, 0.90-0.99) but variable (range, 0.12-.84) sensitivity compared with direct observation, with the lowest sensitivities for health behavior counseling. The NAMCS physician report method overestimated visit duration in comparison with direct observation (16.5 vs. 12.8 minutes). CONCLUSIONS: Compared with direct observation of outpatient visits, the NAMCS physician report method is more accurate for procedures and examinations than for health behavior counseling. Underreporting of behavioral counseling and overreporting of visit duration should lead to caution in interpreting findings based on these variables.
Gilchrist Valerie J; Stange Kurt C; Flocke Susan A; McCord Gary; Bourguet Claire C
Medical care
2004
2004-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/01.mlr.0000114916.95639.af" target="_blank" rel="noreferrer noopener">10.1097/01.mlr.0000114916.95639.af</a>