Despite efforts to reduce overprescribing, antibiotic use is growing among the veteran population and is prescribed for acute respiratory infections, according to research published in the July issue of Annals of Internal Medicine.
The goal of the retrospective, cross-sectional study was to examine trends in antibiotic prescribing in the Veterans Affairs population over an eight-year period and to identify patient, provider and setting sources of variation.
Researchers examined the electronic health records of more than 1 million Veterans Affairs health system center visits between 2005 and 2012, looking specifically at ARI diagnoses. Those included emergency department, primary and urgent care clinic visits.
Antibiotics were given in more than two-thirds of visits for ARIs at Veterans Affairs centers, according to the study. Proportion of visits with antibiotic prescriptions rose slightly during the study from 67.5% in 2005 to 69.2% in 2012. Macrolides accounted for nearly half of the antibiotic prescriptions.
The proportion of macrolide antibiotics prescribed increased from 36.8% to 47.0%. Antibiotic prescribing was highest for sinusitis (adjusted proportion, 86%) and bronchitis (85%) and varied little according to fever, age, setting or comorbid conditions. Substantial variation was identified in prescribing at the provider level.
Researchers stated antibiotics were prescribed more frequently for sinusitis or bronchitis, when high fever was present, and in urgent care settings. Prescribing patterns varied greatly across providers. The 10% who prescribed antibiotics most often did so in 95% or more of the ARI visits. Of the 10% who prescribed them the least, antibiotics were given in 40% or fewer visits.
The study included overall antibiotic prescription, macrolide prescription and patient, provider, and setting characteristics derived from the electronic health records. All patient visits with the primary diagnosis of ARI typically had low proportions of bacterial infection. Patients with infections or comorbid conditions that indicated antibiotic use were excluded from the study.
“Veterans with ARIs commonly receive antibiotics, regardless of patient, provider, or setting characteristics,” researchers concluded. “Macrolide use has increased, and substantial variation was identified in antibiotic prescribing at the provider level.”
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