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Variation in Outpatient Antibiotic Dispensing for Respiratory Infections in Children by Clinician Specialty and Treatment Setting

Agiro, Abiy, PhD*; Gautam, Santosh, PhD*; Wall, Eric, MD, MPH; Hackell, Jesse, MD; Helm, Mark, MD, MBA§; Barron, John, PharmD; Zaoutis, Theoklis, MD, MS-CE; Fleming-Dutra, Katherine E., MD**; Hicks, Lauri A., DO**; Rosenberg, Alan, MD††

The Pediatric Infectious Disease Journal: December 2018 - Volume 37 - Issue 12 - p 1248–1254
doi: 10.1097/INF.0000000000002004
Antimicrobial Reports

Background: Antibiotics are commonly prescribed for children with acute respiratory infections (ARIs). This study describes the distribution of ARI diagnoses and specifically quantifies antibiotic dispensing for bronchitis and upper respiratory infection (URI) by treatment setting and specialty.

Methods: This retrospective, observational cross-sectional study used data from the HealthCore Integrated Research Environment containing claims from 14 commercial health plans for 2012 to 2014. Children (2–17 years) with first-episode ARI were identified by diagnosis of acute otitis media (AOM), sinusitis, pharyngitis, bronchitis or URI with no competing infections or chronic illnesses. Treatment setting was where diagnoses were made: primary care offices, urgent care centers (UCC), retail health clinics (RHCs) or emergency departments. Primary outcome measure was antibiotic prescription fills from pharmacies within 2 days of start of ARI episode.

Results: For URI, the highest proportions in antibiotic dispensing were ordered by office-based or UCC family physicians (28% and 30%, respectively) and office-based or UCC nurse practitioners/physician assistants (30% and 29%, respectively). Across all settings and specialties, there was high proportion of antibiotic dispensing for bronchitis (75%). Overall, 48% of 544,531 children diagnosed with ARI filled antibiotics. Nurse practitioners/physician assistants in RHC made the most diagnoses of AOM (24%) and streptococcal pharyngitis (22%).

Conclusions: Outreach efforts to decrease antibiotic dispensing for URI can be focused on office-based and UCC family physicians and nurse practitioners/physician assistants. All specialties need widespread interventions to reduce antibiotic dispensing for bronchitis. RHC nurse practitioners/physician assistants can be targeted to reduce high proportion of AOM and streptococcal pharyngitis diagnoses.

From the *Translational Research for Affordability and Quality, HealthCore, Inc, Wilmington, Delaware

Department of Family Medicine, University of Washington, Seattle, Washington

Pomona Pediatrics, Children’s and Women’s Physicians of Westchester, Pomona, New York

§General Pediatrics, Childhood Health Associates of Salem, Salem, Oregon

HealthCore, Inc, Wilmington, Delaware

Division of Infectious Diseases, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania

**Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia

††Medical and Clinical Pharmacy Policy, Anthem, Inc, Chicago, Illinois.

Accepted for publication February 19, 2018.

Funding for this study was provided by Anthem, Inc.

A.A., S.G. and J.B. are employees of HealthCore, Inc., a wholly owned subsidiary of Anthem, Inc. A.R. was an employee of Anthem, Inc., at the time of the study. The other authors have no conflicts of interest to disclose.

Anthem, Inc., had no role in the conduct of the study, interpretation of the data, manuscript preparation or the decision to submit. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of Anthem, Inc., HealthCore, Inc. or the Centers for Disease Control and Prevention.

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Address correspondence to: Abiy Agiro, PhD, HealthCore, Inc., 123 Justison Street, Suite 200, Wilmington, DE 19801. E-mail:

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.