Association between Physician Intensity of Antibiotic Prescribing and the Prescription of Benzodiazepines, Opioids and P
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Department of Medicine, University of Toronto, Toronto, ON, Canada; 2ICES, Toronto, ON, Canada; 3Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; 4Department of Medicine, Sinai Health System, Toronto, Ontario, Canada; 5Sunnybrook Research Institute, Toronto, ON, Canada; 6Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; 7Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada; 8Division of Geriatric Medicine, University of Toronto, Toronto, ON, Canada; 9Department of Medicine, University Health Network, Toronto, ON, Canada; 10St. Michael’s Hospital, Toronto, ON, Canada; 11Schools of Pharmacy and Public Health & Health Systems, University of Waterloo, Waterloo, ON, Canada.
BACKGROUND: Prescribing patterns for episodic medications, such as antibiotics, might make useful surrogate measures of a physician’s overall prescribing practice because use is common, and variation exists across prescribers. However, the extent to which a physician’s current antibiotic prescribing practices are associated with the rate of prescription of other potentially harmful medications remains unknown. OBJECTIVE: To examine the association between a physician’s rate of antibiotic prescribing and their prescribing rate of benzodiazepines, opioids and proton-pump inhibitors in older adults. DESIGN: Population-based cohort study in nursing homes in Ontario, Canada, which provides comprehensive clinical, behavioural and functional information on all patients. PARTICIPANTS: 1926 physicians who provided care among 128,979 physician-patient pairs in 2015. MAIN MEASURES: Likelihood of prescribing a benzodiazepine, opioid or proton-pump inhibitor between low-, average- and high-intensity antibiotic prescribers, adjusted for patient characteristics. KEY RESULTS: Compared with average-intensity antibiotic prescribers, high-intensity prescribers had an increased likelihood of prescribing a benzodiazepine (odds ratio 1.21 [95% CI, 1.11–1.32]), an opioid (odds ratio 1.28 [95% CI, 1.17–1.39]) or a proton-pump inhibitor (odds ratio 1.38 [95% CI, 1.27–1.51]]. High-intensity antibiotic prescribers were more likely to be high prescribers of all three medications (odds ratio 6.24 [95% CI, 2.90–13.39])
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-019-05333-8) contains supplementary material, which is available to authorized users. Received January 8, 2019 Revised July 11, 2019 Accepted August 21, 2019
and also more likely to initiate all three medications, compared with average-intensity prescribers. CONCLUSIONS: The intensity of a physician’s episodic antibiotic prescribing was significantly associated with the likelihood of new and continued prescribing of opioids, benzodiazepines and proton-pump inhibitors in nursing homes. Patterns of episodic prescribing may be a useful mechanism to target physician-level interventions to optimize general prescribing behaviors,
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