Abstract:
OBJECTIVES:To identify the frequency with which antibiotics are prescribed in the absence of a documented indication in the ambulatory care setting, to quantify the potential effect on assessments of appropriateness of antibiotics, and to understand patient, provider, and visit level characteristics associated with antibiotic prescribing without a documented indication. DESIGN:Cross sectional study. SETTING:2015 National Ambulatory Medical Care Survey. PARTICIPANTS:28 332 sample visits representing 990.9 million ambulatory care visits nationwide. MAIN OUTCOME MEASURES:Overall antibiotic prescribing and whether each antibiotic prescription was accompanied by appropriate, inappropriate, or no documented indication as identified through ICD-9-CM (international classification of diseases, 9th revision, clinical modification) codes. Survey weighted multivariable logistic regression was used to evaluate potential risk factors for receipt of an antibiotic prescription without a documented indication. RESULTS:Antibiotics were prescribed during 13.2% (95% confidence interval 11.6% to 13.7%) of the estimated 990.8 million ambulatory care visits in 2015. According to the criteria, 57% (52% to 62%) of the 130.5 million prescriptions were for appropriate indications, 25% (21% to 29%) were inappropriate, and 18% (15% to 22%) had no documented indication. This corresponds to an estimated 24 million prescriptions without a documented indication. Being an adult male, spending more time with the provider, and seeing a non-primary care specialist were significantly positively associated with antibiotic prescribing without an indication. Sulfonamides and urinary anti-infective agents were the antibiotic classes most likely to be prescribed without documentation. CONCLUSIONS:This nationally representative study of ambulatory visits identified a large number of prescriptions for antibiotics without a documented indication. Antibiotic prescribing in the absence of a documented indication may severely bias national estimates of appropriate antibiotic use in this setting. This study identified a wide range of factors associated with antibiotic prescribing without a documented indication, which may be useful in directing initiatives aimed at supporting better documentation.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Ray MJ,Tallman GB,Bearden DT,Elman MR,McGregor JCdoi
10.1136/bmj.l6461subject
Has Abstractpub_date
2019-12-11 00:00:00pages
l6461eissn
0959-8138issn
1756-1833journal_volume
367pub_type
杂志文章,多中心研究abstract::To study a range of possible risk factors for HIV among injecting drug user patients attending a clinic in London were interviewed from November 1986 to November 1987. Serum samples were tested for viral markers. Of 116 patients, 101 had shared injecting equipment, 75 on the first occasion of injecting and 76 during t...
journal_title:BMJ (Clinical research ed.)
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更新日期:1989-04-22 00:00:00
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更新日期:2000-07-08 00:00:00
abstract:OBJECTIVE:To estimate the risk of breast cancer associated with diagnostic radiation in carriers of BRCA1/2 mutations. DESIGN:Retrospective cohort study (GENE-RAD-RISK). SETTING:Three nationwide studies (GENEPSO, EMBRACE, HEBON) in France, United Kingdom, and the Netherlands, PARTICIPANTS:1993 female carriers of BRC...
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pub_type: 杂志文章
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更新日期:2012-09-06 00:00:00
abstract:OBJECTIVES:To compare the clinical and cost effectiveness of total hip arthroplasty with resurfacing arthroplasty in patients with severe arthritis of the hip. DESIGN:Single centre, two arm, parallel group, assessor blinded, randomised controlled trial with 1:1 treatment allocation. SETTING:One large teaching hospita...
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pub_type: 杂志文章,随机对照试验
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更新日期:2012-04-19 00:00:00
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pub_type: 杂志文章
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更新日期:1997-07-05 00:00:00
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pub_type: 杂志文章
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更新日期:1995-01-28 00:00:00
abstract:OBJECTIVES:To document the extent to which maternity data are collected and how they are recorded, and to identify problems that may affect their availability throughout the NHS. METHODS:Postal survey in September 1997 with structured questionnaires. SETTING:207 NHS trusts with maternity units in England. PARTICIPAN...
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更新日期:1999-09-04 00:00:00
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pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1999-11-06 00:00:00
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更新日期:2000-05-06 00:00:00
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更新日期:1990-09-22 00:00:00
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更新日期:2019-01-02 00:00:00
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更新日期:2016-03-29 00:00:00
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pub_type: 临床试验,杂志文章,meta分析,随机对照试验
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pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.330.7499.1059
更新日期:2005-05-07 00:00:00
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pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.h3576
更新日期:2015-07-21 00:00:00
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更新日期:1994-03-12 00:00:00
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更新日期:2019-03-27 00:00:00
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更新日期:2004-02-21 00:00:00
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更新日期:2012-04-05 00:00:00
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更新日期:2006-07-15 00:00:00
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更新日期:1995-02-11 00:00:00
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更新日期:1996-01-06 00:00:00
abstract:OBJECTIVE:To assess the effect of the timing of first postnatal home visit by community health workers on neonatal mortality. DESIGN:Analysis of prospectively collected data using time varying discrete hazard models to estimate hazard ratios for neonatal mortality according to day of first postnatal home visit. DATA ...
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pub_type: 杂志文章,随机对照试验
doi:10.1136/bmj.b2826
更新日期:2009-08-14 00:00:00