Antibiotic Prescribing Patterns for Urinary Tract Infections and Pneumonia by Prescriber Type and Specialty in Nursing Home Care, 2016-2018.
Joe B B Silva, Melissa R Riester, Andrew R Zullo
PMID 38428833WHAT IT FOUND
Nursing home specialists prescribed fewer fluoroquinolones for UTIs but more for pneumonia than non-specialists.
Fluoroquinolone use dropped over time for all prescribers. Physicians generally used shorter treatment durations than advanced practice practitioners.
Key findings
01Nursing home specialists prescribed a smaller proportion of fluoroquinolones than non-specialists for UTIs, but a greater proportion for pneumonia.
02Fluoroquinolone prescribing for both UTIs and pneumonia decreased across all prescriber groups from 2016 to 2018.
03Physicians were more likely to prescribe antibiotics for shorter durations for several classes compared to advanced practice practitioners.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study could not determine the clinical indication for each antibiotic (e.g., prophylaxis vs. treatment) because Medicare Part D claims lack this data. Infections were identified from quarterly MDS assessments, so infections occurring between assessments were missed. Clinical appropriateness of the antibiotic choice could not be assessed due to lack of laboratory and imaging results. The definition of 'nursing home specialist' (≥90% of prescriptions for NH residents) is a claims-based proxy and may not capture all aspects of specialization.
The easy way to misread this
Do not interpret the decrease in total UTI antibiotic prescriptions as a direct result of the prescriber characteristics studied; the authors suggest this may reflect improved diagnostic criteria and stewardship efforts, but the study design does not prove causality.