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Variation in US Outpatient Antibiotic Prescribing Quality Measures According to Health Plan and Geography
Rebecca M. Roberts, MS; Lauri A. Hicks, DO; and Monina Bartoces, PhD
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Variation in US Outpatient Antibiotic Prescribing Quality Measures According to Health Plan and Geography

Rebecca M. Roberts, MS; Lauri A. Hicks, DO; and Monina Bartoces, PhD
Antibiotic prescribing has become viewed as a patient safety and quality-of-care issue. The authors analyzed quality measures related to appropriate antibiotic prescribing and testing.
Finally, interventions to improve antibiotic use should target providers who treat adults, specifically for the diagnosis of acute bronchitis, as progress has been minimal. Healthcare providers cite diagnostic uncertainty, time limitations (eg, not enough time to communicate about appropriate use with patients), and patient demand as reasons for prescribing antibiotics even when they are not clinically indicated.19,20 Because guidelines and information on management of bronchitis have been available for many years, it may take more focused and deliberate efforts to engage adult providers. We are hopeful, however, that progress can be made based on the improvements seen in prescribing for children after a concerted effort was made to engage pediatric providers around this issue. Interventions at the clinician level, such as audit and feedback, clinical decision support tools, and active education strategies, such as academic detailing, may be useful for improving prescribing practices.
There were limitations associated with this analysis. As shown in the Table, not every health plan reported data for every measure or for every year. Health plans may go out of business, relocate, or choose not to report on these measures. Also, these data only include commercial lines of business within health plans and do not include Medicare or Medicaid lines of business, which may differ due to the unique populations represented. Additionally, the measures associated with antibiotic prescribing rely on data gathered from medical chart reviews, and, specifically, diagnostic codes. Diagnostic coding can be unreliable and is another limitation associated with this study.
With antibiotic-resistant infections on the rise, and a strong interest and level of support from the White House—given the release of the National Strategy for Combating Antibiotic-Resistant Bacteria,18 the National Action Plan for Combating Antibiotic-Resistant Bacteria21 and a Presidential Executive Order22— to improve antibiotic stewardship, the time to focus efforts on improving prescribing practices in the outpatient setting is now. Armed with the knowledge of where inappropriate prescribing is most common and support for this topic on a national level, public health professionals, health plans, provider groups, and other stakeholders invested in antibiotic stewardship can begin to deliberately focus interventions where improvement is most needed. 

Author Affiliations: Get Smart: Know When Antibiotics Work program, Centers for Disease Control and Prevention (RMR, LAH, MB), Atlanta, GA.

Source of Funding: None.

Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (MB, LAH, RMR); acquisition of data (RMR); analysis and interpretation of data (MB, LAH, RMR); drafting of the manuscript (RMR); critical revision of the manuscript for important intellectual content (LAH, RMR); statistical analysis (MB); and supervision (LAH).

Address Correspondence to: Rebecca M. Roberts, MS, 1600 Clifton Rd, MS A-31, Atlanta, GA 30329. E-mail:

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