New research finds that doctors practising family medicine are more likely to prescribe antibiotics compared to doctors working in hospitals and emergency medicine in the USA.
The research, conducted by scientists at the University of Oxford and the Baylor College of Medicine in Texas assessed antibiotic utilisation across the US for almost a decade. The researchers evaluated several metrics of antibiotic prescription (days supplied, claims rate, days per claim and cost) and adjusted per the number of beneficiaries to account for practice size.
The study published in JAC-Antimicrobial Resistance examined the impact of medical school ranking on outpatient antibiotic prescriptions among Medicare Part D providers (the part of Medicare that provides prescription drug coverage). Analysing data from 197,540 providers from 2013 to 2021, the study found no significant relationship between school ranking and prescription rates. However, factors like provider type, years of experience, and location influenced prescribing behaviours.
- Years of experience: Researchers found that students and experienced health providers working for over 20 years prescribe more antibiotics compared to providers with less than 20 years of experience. The study suggests that providers with less experience tend to prescribe fewer antibiotics as antibiotic stewardship training courses in the US are relatively new and the more experienced providers may be less familiar with stewardship guidelines and efforts.
- Provider type: Family Medicine and Internal Medicine providers represent only 25% of all prescribers in the study, yet they made up 52% of the highest volume prescribers. This could be because doctors working in hospitals and emergency medicine may only write a short course of therapy and defer longer courses or refills to primary care physicians.
- Location: While only 36% of all prescribers are located in the US South, this region accounted for 48% of the highest volume prescribers (top 10% of total prescribers).
The study suggests that variability in antimicrobial stewardship training across US medical schools may contribute to disparities in prescribing behaviours. While some schools have adopted comprehensive, evidence-based stewardship curricula, others offer limited instruction, leading to potential gaps in clinical practice.
“Understanding the behavioral factors influencing antibiotic prescribing is key to reducing over prescription and combating antimicrobial resistance. This study highlights significant disparities based on provider type, experience, and location, emphasizing the need for standardized and comprehensive antimicrobial stewardship training in medical education across the US."
