Healthcare Claims Data: An Underutilized Tool for Pediatric Outpatient Antimicrobial Stewardship.
Healthcare claims are underutilized to identify factors associated with high outpatient antibiotic use.
We evaluated ambulatory encounter claims of Medicaid-insured children in 34 Ohio counties in 2014. Rates of total antibiotic and azithromycin prescriptions dispensed were determined by county of patient residence. Standardized treatment rates by county were estimated for uncomplicated upper respiratory tract encounters (acute otitis media, pharyngitis, sinusitis, presumed viral infection) after adjusting for patient age and encounter provider type. Uncomplicated encounters included healthy children at initial presentation of illness. Adjusted odds of treatment were calculated for patient age, provider type, and county characteristics (rural vs metropolitan; poverty rate).
Retail pharmacies dispensed 255291 antibiotics to this cohort in 2014. More than 25% were to children <3 years. County rates of total antibiotic and azithromycin prescriptions dispensed were 530.4-1548.3 and 57.3-378.7 per 1000 person-years, respectively. Of 246866 uncomplicated upper respiratory tract encounters, antibiotics were dispensed (within 3 days) in 46.1%. Presumed viral infection accounted for 18.5% of antibiotics. Standardized treatment rates by county ranged widely from 35.9% (95% confidence interval [CI], 33.3%-38.5%) to 63.2% (95% CI, 61.5%-64.9%). Compared to encounters with pediatricians, adjusted odds ratio of treatment was 2.02 (95% CI, 1.96-2.07) for family physicians and 1.74 (95% CI, 1.68-1.79) for nurse practitioners. Residence in rural or high-poverty counties increased odds of treatment.
Healthcare claims were useful to identify populations and providers with high antibiotic use. Claims data could be considered to track and report antibiotic prescribing frequency, especially where electronic medical records are not available.
Department of Pediatrics, The Ohio State University.|Nationwide Children's Hospital, Partners for Kids ; and.
Joshua R
JR
Watson
Nationwide Children's Hospital, Partners for Kids; and.
Ling
L
Wang
Nationwide Children's Hospital, Partners for Kids; and.
Jennifer
J
Klima
Biostatistics Core, Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
Melissa
M
Moore-Clingenpeel
Department of Pediatrics, The Ohio State University.|Nationwide Children's Hospital, Partners for Kids ; and.
Sean
S
Gleeson
Department of Pediatrics, The Ohio State University.|Nationwide Children's Hospital, Partners for Kids ; and.
Kelly
K
Kelleher
Department of Pediatrics, The Ohio State University.|Nationwide Children's Hospital, Partners for Kids ; and.
Preeti
P
Jaggi
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000073602:Antimicrobial Stewardship; D017963:Azithromycin / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D010033:Otitis Media / Q000188:drug therapy / Q000453:epidemiology; D010045:Outpatients; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012852:Sinusitis / Q000188:drug therapy / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
D000900:Anti-Bacterial Agents; D017963:Azithromycin
antibiotics; antimicrobial stewardship; azithromycin; healthcare claims; pediatric