title: Variation in Outpatient Antibiotic Prescribing for Acute Respiratory Infections in the Veteran Population: A Cross-sectional Study.
abstract: BACKGROUND
  Despite efforts to reduce antibiotic prescribing for acute respiratory infections (ARIs), information on factors that drive prescribing is limited.
  
  
  OBJECTIVE
  To examine trends in antibiotic prescribing in the Veterans Affairs population over an 8-year period and to identify patient, provider, and setting sources of variation.
  
  
  METHODS
  Retrospective, cross-sectional study.
  
  
  METHODS
  All emergency departments and primary and urgent care clinics in the Veterans Affairs health system.
  
  
  METHODS
  All patient visits between 2005 and 2012 with primary diagnoses of ARIs that typically had low proportions of bacterial infection. Patients with infections or comorbid conditions that indicated antibiotic use were excluded.
  
  
  METHODS
  Overall antibiotic prescription; macrolide prescription; and patient, provider, and setting characteristics extracted from the electronic health record.
  
  
  RESULTS
  The proportion of 1 million visits with ARI diagnoses that resulted in antibiotic prescriptions increased from 67.5% in 2005 to 69.2% in 2012 (P < 0.001). The proportion of macrolide antibiotics prescribed increased from 36.8% to 47.0% (P < 0.001). 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: The 10% of providers who prescribed the most antibiotics did so during at least 95% of their ARI visits, and the 10% who prescribed the least did so during 40% or fewer of their ARI visits.
  
  
  CONCLUSIONS
  Some clinical data that may have influenced the prescribing decision were missing.
  
  
  CONCLUSIONS
  Veterans with ARIs commonly receive antibiotics, regardless of patient, provider, or setting characteristics. Macrolide use has increased, and substantial variation was identified in antibiotic prescribing at the provider level.
  
  
  BACKGROUND
  U.S. Department of Veterans Affairs, Centers for Disease Control and Prevention.
authors.forename: Barbara Ellen
authors.initials: BE
authors.lastname: Jones
authors.forename: Brian
authors.initials: B
authors.lastname: Sauer
authors.forename: Makoto M
authors.initials: MM
authors.lastname: Jones
authors.forename: Jose
authors.initials: J
authors.lastname: Campo
authors.forename: Kavitha
authors.initials: K
authors.lastname: Damal
authors.forename: Tao
authors.initials: T
authors.lastname: He
authors.forename: Jian
authors.initials: J
authors.lastname: Ying
authors.forename: Tom
authors.initials: T
authors.lastname: Greene
authors.forename: Matthew Bidwell
authors.initials: MB
authors.lastname: Goetz
authors.forename: Melinda M
authors.initials: MM
authors.lastname: Neuhauser
authors.forename: Lauri A
authors.initials: LA
authors.lastname: Hicks
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Samore
mesh_terms: D000208:Acute Disease; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data* / Q000639:trends; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D006801:Humans; D018942:Macrolides / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D012189:Retrospective Studies; D014481:United States; D014728:Veterans
chemical_list: D000900:Anti-Bacterial Agents; D018942:Macrolides