Anzeige
Erschienen in:
01.10.2019 | Original Research
Association between Physician Intensity of Antibiotic Prescribing and the Prescription of Benzodiazepines, Opioids and Proton-Pump Inhibitors to Nursing Home Residents: a Population-Based Observational Study
Erschienen in: Journal of General Internal Medicine | Ausgabe 12/2019
Einloggen, um Zugang zu erhaltenAbstract
Background
Prescribing patterns for episodic medications, such as antibiotics, might make useful surrogate measures of a physician’s overall prescribing practice because use is common, and variation exists across prescribers. However, the extent to which a physician’s current antibiotic prescribing practices are associated with the rate of prescription of other potentially harmful medications remains unknown.
Objective
To examine the association between a physician’s rate of antibiotic prescribing and their prescribing rate of benzodiazepines, opioids and proton-pump inhibitors in older adults.
Design
Population-based cohort study in nursing homes in Ontario, Canada, which provides comprehensive clinical, behavioural and functional information on all patients.
Participants
1926 physicians who provided care among 128,979 physician-patient pairs in 2015.
Main Measures
Likelihood of prescribing a benzodiazepine, opioid or proton-pump inhibitor between low-, average- and high-intensity antibiotic prescribers, adjusted for patient characteristics.
Key Results
Compared with average-intensity antibiotic prescribers, high-intensity prescribers had an increased likelihood of prescribing a benzodiazepine (odds ratio 1.21 [95% CI, 1.11–1.32]), an opioid (odds ratio 1.28 [95% CI, 1.17–1.39]) or a proton-pump inhibitor (odds ratio 1.38 [95% CI, 1.27–1.51]]. High-intensity antibiotic prescribers were more likely to be high prescribers of all three medications (odds ratio 6.24 [95% CI, 2.90–13.39]) and also more likely to initiate all three medications, compared with average-intensity prescribers.
Conclusions
The intensity of a physician’s episodic antibiotic prescribing was significantly associated with the likelihood of new and continued prescribing of opioids, benzodiazepines and proton-pump inhibitors in nursing homes. Patterns of episodic prescribing may be a useful mechanism to target physician-level interventions to optimize general prescribing behaviors, instead of prescribing behaviors for single medications.