Doctoral Student Brown University School of Public Health Providence, United States
Background: Potentially inappropriate antibiotic prescribing is common among nursing home (NH) residents. Differences in antibiotic prescribing practices by provider type and specialization in NH care are essential to inform antibiotic stewardship efforts, but are unknown.
Objectives: To assess differences in medication class and duration of therapy for antibiotic dispensings prescribed by NH specialist physicians, non-NH specialist physicians, NH specialist advanced practitioners (APs), and non-NH specialist APs for urinary tract infection (UTI) and pneumonia.
Methods: This national cross-sectional study included Traditional Medicare beneficiaries aged ≥65 years residing long-term in United States NHs with documented UTI or pneumonia infections between 2016 and 2018. Minimum Data Set clinical assessments were linked to Medicare claims data (Part D prescription drug claims, enrollment information, inpatient hospital claims, and provider characteristics). We excluded antibiotic dispensings missing provider information or for residents enrolled in Medicare Advantage, diagnosed concurrently with UTI and pneumonia, with a recent hospitalization, or missing covariate information. The comparisons of interest were provider type (physician, AP) and NH specialization. NH-specialists were defined as providers with ≥ 90% of all medication dispensings to NH residents in a given year. The main outcome measures were the distribution of total dispensings and duration of therapy by antibiotic class.
Results: The study included 264,828 antibiotic dispensings for 140,360 long-term care NH residents; 214,759 dispensings for UTI and 49,976 for pneumonia. Fluoroquinolones were the most prevalent antibiotic class for UTI and pneumonia across providers. NH specialists were less likely to dispense fluoroquinolones for UTI compared to non-NH specialists (NH specialist versus non-NH specialist physician: 22.9% vs. 23.9% of all antibiotic dispensings for UTI; NH-specialist versus non-NH specialist APs: 21.3% vs. 24.2%). Fluoroquinolone prescribing for pneumonia was similar across providers (NH specialist versus non-NH specialist physician: 38.9% vs. 37.8%; NH-specialist versus non-NH specialist APs: 38.8% vs. 37.3%). The median duration of antibiotic therapy was largely consistent across provider types for UTI, but dispensings for pneumonia for several antibiotic classes were longest among non-NH APs.
Conclusions: Given differences in antibiotic use between NH prescriber specialization, there may be a role for targeting antibiotic stewardship efforts to particular provider groups, such as non-NH-specialist practitioners who prescribe in NHs.
