title: Differences in antibiotic prescribing among physicians, residents, and nonphysician clinicians.
abstract: OBJECTIVE
  State legislatures have increased the prescribing capabilities of nurse practitioners and physician assistants and broadened the scope of their practice roles. To determine the impact of these changes, we compared outpatient antibiotic prescribing by practicing physicians, nonphysician clinicians, and resident physicians.
  
  
  METHODS
  Using the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS), we conducted a cross-sectional study of patients >/=18 years of age receiving care in 3 outpatient settings: office practices, hospital practices, and emergency departments, 1995-2000. We measured the proportion of all visits and visits for respiratory diagnoses where antibiotics are rarely indicated in which an antibiotic was prescribed by practitioner type.
  
  
  RESULTS
  For all patient visits, nonphysician clinicians were more likely to prescribe antibiotics than practicing physicians for visits in office practices (26.3% vs 16.2%), emergency departments (23.8% vs 18.2%), and hospital clinics (25.2% vs 14.6%). Similarly, for the subset of visits for respiratory conditions where antibiotics are rarely indicated, nonphysician clinicians prescribed antibiotics more often than practicing physicians in office practices (odds ratio [OR] 1.86, 95% confidence intervals [CI]: 1.05 to 3.29), and in hospital practices (OR 1.55, 95% CI: 1.12 to 2.15). In hospital practices, resident physicians had lower prescribing rates than practicing physicians for all visits as well as visits for respiratory conditions where antibiotics are rarely indicated (OR 0.56, 95% CI: 0.36 to 0.86).
  
  
  CONCLUSIONS
  Nonphysician clinicians were more likely to prescribe antibiotics than practicing physicians in outpatient settings, and resident physicians were less likely to prescribe antibiotics. These differences suggest that general educational campaigns to reduce antibiotic prescribing have not reached all providers.
authors.affiliation: Quality Scholars Program, Veterans Administration Tennessee Valley Healthcare System-Health Services Research and Development, Nashville, Tennessee, USA. christianne.roumie@vanderbilt.edu
authors.forename: Christianne L
authors.initials: CL
authors.lastname: Roumie
authors.forename: Natasha B
authors.initials: NB
authors.lastname: Halasa
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Edwards
authors.forename: Yuwei
authors.initials: Y
authors.lastname: Zhu
authors.forename: Robert S
authors.initials: RS
authors.lastname: Dittus
authors.forename: Marie R
authors.initials: MR
authors.lastname: Griffin
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D004363:Drug Utilization; D006801:Humans; D007396:Internship and Residency; D010820:Physicians; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*
chemical_list: D000900:Anti-Bacterial Agents