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http://conacyt.repositorioinstitucional.mx/jspui/handle/1000/288| Dissecting the mechanisms of a 5-year decline in antibiotic prescribing | |
| R. Monina Klevens Michael L. Barnett Yonatan H. Grad Stephen M Kissler | |
| Novel Coronavirus | |
| Acceso Abierto | |
| Sin Derechos Reservados | |
| 10.1101/2020.01.02.20016329 | |
| Importance: The mechanisms driving the recent decline in outpatient antibiotic prescribing are unknown. Objective: To estimate the extent to which reductions in the number of antibiotic prescriptions filled per outpatient visit (stewardship) and reductions in the monthly rate of outpatient visits (observed disease) for infectious disease conditions each contributed to the decline in annual outpatient antibiotic prescribing rate in Massachusetts between 2011 and 2015. Design: Outpatient medical and pharmacy claims from the Massachusetts All-Payer Claims Database were used to estimate rates of antibiotic prescribing and outpatient visits for 20 medical conditions and their contributions to the overall decline in antibiotic prescribing. Trends were compared to those in the National Ambulatory Medical Care Survey (NAMCS). Setting: Outpatient visits in Massachusetts between January 2011 and September 2015. Participants: 5,075,908 individuals with commercial health insurance or Medicaid in Massachusetts under the age of 65 and 495,515 patients included in NAMCS. Main outcomes and measures: The number of antibiotic prescriptions avoided through reductions in observed disease and reductions in per-visit prescribing rate per medical condition. Results: Between 2011 and 2015, the January antibiotic prescribing rate per 1,000 individuals in Massachusetts declined by 18.9% and the July antibiotic prescribing rate declined by 13.6%. The mean prescribing rate for children under 5 declined by 42.8% (95% CI 21.7%, 59.4%), principally reflecting reduced wintertime prescribing. The monthly rate of outpatient visits per 1,000 individuals in Massachusetts declined (p < 0.05) for respiratory infections and urinary tract infections. Nationally, visits for medical conditions that merit an antibiotic prescription also declined between 2010 and 2015. Of the estimated 358 antibiotic prescriptions per 1,000 individuals avoided over the study period in Massachusetts, 59% (95% CI 54%, 63%) were attributable to reductions in observed disease and 41% (95% CI 37%, 46%) to reductions in prescribing per outpatient visit. Conclusions and relevance: The decline in antibiotic prescribing in Massachusetts was driven by a decline in observed disease and improved antibiotic stewardship, with a contemporaneous reduction in visits for conditions prompting antibiotics observed nationally. A focus on infectious disease prevention should be considered alongside antibiotic stewardship as a means to reduce antibiotic prescribing. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement No funding was received for conducting this work. The authors were employees of the Harvard Chan School of Public Health or Massachusetts Department of Public Health. ### Author Declarations All relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript. Yes All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Massachusetts APCD data are available from the Center for Health Information and Analysis[25]. NAMCS data are available from the Centers for Disease Control and Prevention[27]. Code for reproducing our analysis is available at https://github.com/skissler/disease-stewardship-ms. <https://github.com/skissler/disease-stewardship-ms> | |
| Cold Spring Harbor Laboratory Press | |
| 2020 | |
| Preimpreso | |
| https://www.medrxiv.org/content/10.1101/2020.01.02.20016329v1 | |
| Inglés | |
| VIRUS RESPIRATORIOS | |
| Aparece en las colecciones: | Artículos científicos |
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|---|---|---|---|
| Dissecting the mechanisms.pdf | 2.01 MB | Adobe PDF | Visualizar/Abrir |