title: Provider and patient drivers of ototopical antibiotic prescription variability.
abstract: OBJECTIVE
  To determine if providers prescribe more affordable topical antibacterial therapy for patients who are economically disadvantaged or come from economically disadvantaged communities.
  
  
  METHODS
  Prescription drug database review.
  
  
  METHODS
  Large academic hospital network.
  
  
  METHODS
  Ototopical prescription records of 2416 adults and children presenting with acute and chronic otologic infections from 2009 to 2013 were reviewed. Prescription, patient, provider, and institution variables including diagnosis, prescription type, demographics, health insurance status, healthcare provider type and setting were analyzed.
  
  
  RESULTS
  Otitis externa and acute otitis media were the most common diagnoses. Non-OHNS (Otolaryngology-Head and Neck Surgery) providers served 82% of all patients. OHNS providers prescribed proportionally less fluoroquinolone, and more brand-name antibiotics compared to non-OHNS providers. Adults were more likely to receive a non-fluoroquinolone antibiotic and a generic prescription versus pediatric patients. Patients who self-identified as 'white' ethnicity received proportionally more fluoroquinolone prescriptions than patients who identified as 'non-white,' but there was no difference in provider type. The proportion of fluoroquinolone prescriptions was significantly higher in patients from low-poverty counties, however poverty level was not associated with patients seeing a particular provider type. The majority of our patients had commercial insurance, followed by Medicaid. Medicare patients had the lowest proportion of fluoroquinolone antibiotic prescriptions, and were less likely to receive fluoroquinolone prescriptions versus commercial insurance. Non-insured patients received proportionally more generic versus brand prescriptions than insured patients.
  
  
  CONCLUSIONS
  Our results indicate potential provider, patient demographic, and financial factors producing considerable variability in the prescribing patterns for topical antibiotics for common otologic infections.
authors.affiliation: Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, Durham, NC. Electronic address: matthew.crowson@dm.duke.edu.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Crowson
authors.affiliation: Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Kristine C
authors.initials: KC
authors.lastname: Schulz
authors.affiliation: Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Debara L
authors.initials: DL
authors.lastname: Tucci
mesh_terms: D000046:Academic Medical Centers; D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D016568:Drugs, Generic; D005260:Female; D024841:Fluoroquinolones; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D010032:Otitis Externa / Q000188:drug therapy / Q000453:epidemiology; D010033:Otitis Media / Q000188:drug therapy / Q000453:epidemiology; D011204:Poverty Areas; D044469:Racial Groups / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data; D018058:Tympanic Membrane Perforation / Q000188:drug therapy / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D016568:Drugs, Generic; D024841:Fluoroquinolones