Wattles Bethany A, Jawad Kahir S, Feygin Yana, Kong Maiying, Vidwan Navjyot K, Stevenson Michelle D, Smith Michael J
Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky.
Department of Bioinformatics and Biostatistics, University of Louisville School of Public Health and Information Sciences, Louisville, Kentucky.
Infect Control Hosp Epidemiol. 2022 May;43(5):582-588. doi: 10.1017/ice.2021.177. Epub 2021 May 12.
To describe risk factors associated with inappropriate antibiotic prescribing to children.
Cross-sectional, retrospective analysis of antibiotic prescribing to children, using Kentucky Medicaid medical and pharmacy claims data, 2017.
Population-based sample of pediatric Medicaid patients and providers.
Antibiotic prescriptions were identified from pharmacy claims and used to describe patient and provider characteristics. Associated medical claims were identified and linked to assign diagnoses. An existing classification scheme was applied to determine appropriateness of antibiotic prescriptions.
Overall, 10,787 providers wrote 779,813 antibiotic prescriptions for 328,515 children insured by Kentucky Medicaid in 2017. Moreover, 154,546 (19.8%) of these antibiotic prescriptions were appropriate, 358,026 (45.9%) were potentially appropriate, 163,654 (21.0%) were inappropriate, and 103,587 (13.3%) were not associated with a diagnosis. Half of all providers wrote 12 prescriptions or less to Medicaid children. The following child characteristics were associated with inappropriate antibiotic prescribing: residence in a rural area (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.07-1.1), having a visit with an inappropriate prescriber (OR, 4.15; 95% CI, 4.1-4.2), age 0-2 years (OR, 1.39; 95% CI, 1.37-1.41), and presence of a chronic condition (OR, 1.31; 95% CI, 1.28-1.33).
Inappropriate antibiotic prescribing to Kentucky Medicaid children is common. Provider and patient characteristics associated with inappropriate prescribing differ from those associated with higher volume. Claims data are useful to describe inappropriate use and could be a valuable metric for provider feedback reports. Policies are needed to support analysis and dissemination of antibiotic prescribing reports and should include all provider types and geographic areas.
描述与儿童不恰当抗生素处方相关的风险因素。
利用2017年肯塔基医疗补助计划的医疗和药房报销数据，对儿童抗生素处方进行横断面回顾性分析。
基于人群的儿科医疗补助患者和提供者样本。
从药房报销记录中识别抗生素处方，并用于描述患者和提供者特征。识别相关医疗报销记录并进行关联以确定诊断。应用现有的分类方案来确定抗生素处方的适当性。
2017年，共有10787名提供者为肯塔基医疗补助计划承保的328515名儿童开具了779813份抗生素处方。此外，这些抗生素处方中154546份（19.8%）是适当的，358026份（45.9%）可能是适当的，163654份（21.0%）是不适当的，103587份（13.3%）与诊断无关。所有提供者中有一半为医疗补助儿童开具的处方为12份或更少。以下儿童特征与不恰当抗生素处方相关：居住在农村地区（比值比[OR]，1.09；95%置信区间[CI]，1.07 - 1.1）、就诊于不适当的开处方者（OR，4.15；95%CI，4.1 - 4.2）、年龄0 - 2岁（OR，1.39；95%CI，1.37 - 1.41）以及患有慢性病（OR，1.31；95%CI，1.28 - 1.33）。
肯塔基医疗补助儿童中不恰当抗生素处方情况常见。与不恰当处方相关的提供者和患者特征与处方量大的情况不同。报销数据有助于描述不恰当使用情况，并且可能是提供者反馈报告中的一个有价值指标。需要制定政策来支持抗生素处方报告的分析和传播，并且应涵盖所有提供者类型和地理区域。
