title: The influence of context on antimicrobial prescribing for febrile respiratory illness: a cohort study.
abstract: BACKGROUND
  Little is known about the influence of contextual factors on a physician's likelihood to prescribe antimicrobials for febrile respiratory illness (FRI). Context includes epidemiologic context (for example, a pandemic period) and personal context (for example, recent exposure to other patients with FRI).
  
  
  OBJECTIVE
  To examine the association between contextual factors and antimicrobial prescribing for FRI.
  
  
  METHODS
  5.5-year retrospective cohort study.
  
  
  METHODS
  A network of Midwestern primary care providers.
  
  
  METHODS
  All patients presenting with FRI during influenza seasons between 2006 and 2011.
  
  
  METHODS
  Antimicrobial prescribing for FRI during pandemic and seasonal influenza periods.
  
  
  RESULTS
  28 301 unique patient encounters for FRI with 69 physicians in 26 practices were included. An antibiotic was prescribed in 12 795 (45.2%) cases. The range of prescribing among physicians was 17.9% to 83.7%. Antibiotics were prescribed in 47.5% of encounters during the seasonal period and 39.2% during the pandemic period (P < 0.001). After multivariable adjustment for patient and physician characteristics, antibiotic prescribing was lower in the pandemic period (odds ratio [OR], 0.72 [95% CI, 0.68 to 0.77]) than in the seasonal period. The likelihood of prescribing an antibiotic decreased as the number of FRI cases that a physician had seen in the previous week increased (OR, 0.93 [CI, 0.86 to 1.01] for 2 to 3 patients with FRI seen in the previous week; OR, 0.84 [CI, 0.77 to 0.91] for 4 to 6 patients; OR, 0.71 [CI, 0.64 to 0.78] for 7 to 11 patients; and OR, 0.57 [CI, 0.51 to 0.63] for ≥12 patients compared with the reference range of 0 to 1 patients). Pandemic season and recent personal context were also associated with antiviral prescribing.
  
  
  CONCLUSIONS
  Retrospective study in a single geographic area.
  
  
  CONCLUSIONS
  Epidemiologic context and the number of cases of FRI that a physician had recently seen were associated with his or her likelihood to prescribe antimicrobials for FRI. Interventions that enhance a physician's contextual awareness may improve antimicrobial use.
  
  
  BACKGROUND
  NorthShore University HealthSystem.
authors.affiliation: The Ohio State University Wexner Medical Center, Department of Biomedical Informatics, 3190 Graves Hall, 333 West Tenth Avenue, Columbus, OH 43210, USA. courtney.hebert@osumc.edu
authors.forename: Courtney
authors.initials: C
authors.lastname: Hebert
authors.forename: Jennifer
authors.initials: J
authors.lastname: Beaumont
authors.forename: Gene
authors.initials: G
authors.lastname: Schwartz
authors.forename: Ari
authors.initials: A
authors.lastname: Robicsek
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005334:Fever / Q000188:drug therapy; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology; D008875:Middle Aged; D058873:Pandemics; D058007:Physicians, Primary Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D012189:Retrospective Studies; D012621:Seasons; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000998:Antiviral Agents