TY - JOUR
T1 - Outpatient Prescribing of Antibiotics and Opioids by Veterans Health Administration Providers, 2015–2017
AU - Evans, Charlesnika T.
AU - Fitzpatrick, Margaret A.
AU - Poggensee, Linda
AU - Gonzalez, Beverly
AU - Gibson, Gretchen
AU - Jurasic, M. Marianne
AU - Echevarria, Kelly
AU - McGregor, Jessina C.
AU - Cunningham, Fran
AU - Gellad, Walid F.
AU - Suda, Katie J.
N1 - Funding Information:
This work was supported by funding from the Veterans Health Administration, Office of Research and Development, Health Services Research and Development Service Investigator-Initiated Research Award (Grant Number HX002452), and the Research Career Scientist Award (RCS 20-192).
Publisher Copyright:
© 2021
PY - 2021/11
Y1 - 2021/11
N2 - Introduction: Antibiotics and opioids are targeted by public health and stewardship communities for reductions in prescribing across the country. This study evaluates trends and factors associated with outpatient prescribing by dental and medical providers in a large integrated health system. Methods: This was a cross-sectional study of national dental and medical outpatient visits from Department of Veterans Affairs facilities in 2015–2017; analyzed in 2019–2020. Antibiotic and opioid prescribing rates were assessed by provider and facility characteristics. Multivariable Poisson regression adjusted for repeated measures by the provider was used to assess the independent association between facility and provider characteristics and rate of prescribing. Results: Over the study period, 4,625,840 antibiotic and 10,380,809 opioid prescriptions were identified for 115,625,890 visits. Physicians prescribed most antibiotics (67%). Dentists prescribed 6% of the antibiotics but had the highest per-visit antibiotic prescribing rate compared to medical providers (6.75 vs 3.90 prescriptions per 100 visits, p<0.0001), which was largely driven by dental specialists. By contrast, dentists had lower opioid prescribing than medical providers (3.02 vs 9.20 prescriptions per 100 visits, p<0.0001). Overall, antibiotic and opioid prescribing decreased over time, with opioids having the greatest decreases (−28.0%). In multivariable analyses, U.S. geographic region, rurality, and complexity were associated with prescribing for both drug classes. Opioid and antibiotic prescribing were positively correlated. Conclusions: Although antibiotic and opioid prescribing has decreased, there are still important target areas for improvement. Interventions need to be tailored to community characteristics such as rurality and provider type.
AB - Introduction: Antibiotics and opioids are targeted by public health and stewardship communities for reductions in prescribing across the country. This study evaluates trends and factors associated with outpatient prescribing by dental and medical providers in a large integrated health system. Methods: This was a cross-sectional study of national dental and medical outpatient visits from Department of Veterans Affairs facilities in 2015–2017; analyzed in 2019–2020. Antibiotic and opioid prescribing rates were assessed by provider and facility characteristics. Multivariable Poisson regression adjusted for repeated measures by the provider was used to assess the independent association between facility and provider characteristics and rate of prescribing. Results: Over the study period, 4,625,840 antibiotic and 10,380,809 opioid prescriptions were identified for 115,625,890 visits. Physicians prescribed most antibiotics (67%). Dentists prescribed 6% of the antibiotics but had the highest per-visit antibiotic prescribing rate compared to medical providers (6.75 vs 3.90 prescriptions per 100 visits, p<0.0001), which was largely driven by dental specialists. By contrast, dentists had lower opioid prescribing than medical providers (3.02 vs 9.20 prescriptions per 100 visits, p<0.0001). Overall, antibiotic and opioid prescribing decreased over time, with opioids having the greatest decreases (−28.0%). In multivariable analyses, U.S. geographic region, rurality, and complexity were associated with prescribing for both drug classes. Opioid and antibiotic prescribing were positively correlated. Conclusions: Although antibiotic and opioid prescribing has decreased, there are still important target areas for improvement. Interventions need to be tailored to community characteristics such as rurality and provider type.
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U2 - 10.1016/j.amepre.2021.05.009
DO - 10.1016/j.amepre.2021.05.009
M3 - Article
C2 - 34376291
AN - SCOPUS:85112108552
SN - 0749-3797
VL - 61
SP - e235-e244
JO - American Journal of Preventive Medicine
JF - American Journal of Preventive Medicine
IS - 5
ER -