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Inappropriate outpatient antibiotic use in children insured by Kentucky Medicaid

Published online by Cambridge University Press:  12 May 2021

Bethany A. Wattles Open the ORCID record for Bethany A. Wattles [Opens in a new window] ,
Kahir S. Jawad ,
Yana Feygin ,
Maiying Kong ,
Navjyot K. Vidwan ,
Michelle D. Stevenson  and
Michael J. Smith
Bethany A. Wattles*
Affiliation:
Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky
Kahir S. Jawad
Affiliation:
Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky
Yana Feygin
Affiliation:
Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky
Maiying Kong
Affiliation:
Department of Bioinformatics and Biostatistics, University of Louisville School of Public Health and Information Sciences, Louisville, Kentucky
Navjyot K. Vidwan
Affiliation:
Norton Children’s and University of Louisville School of Medicine, Louisville, Kentucky
Michelle D. Stevenson
Affiliation:
Norton Children’s and University of Louisville School of Medicine, Louisville, Kentucky
Michael J. Smith
Affiliation:
Duke University Medical Center, Department of Pediatrics, Durham, North Carolina
*
Author for correspondence: Bethany A. Wattles, E-mail: Bethany.wattles@louisville.edu
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Abstract

Objective:

To describe risk factors associated with inappropriate antibiotic prescribing to children.

Design:

Cross-sectional, retrospective analysis of antibiotic prescribing to children, using Kentucky Medicaid medical and pharmacy claims data, 2017.

Participants:

Population-based sample of pediatric Medicaid patients and providers.

Methods:

Antibiotic prescriptions were identified from pharmacy claims and used to describe patient and provider characteristics. Associated medical claims were identified and linked to assign diagnoses. An existing classification scheme was applied to determine appropriateness of antibiotic prescriptions.

Results:

Overall, 10,787 providers wrote 779,813 antibiotic prescriptions for 328,515 children insured by Kentucky Medicaid in 2017. Moreover, 154,546 (19.8%) of these antibiotic prescriptions were appropriate, 358,026 (45.9%) were potentially appropriate, 163,654 (21.0%) were inappropriate, and 103,587 (13.3%) were not associated with a diagnosis. Half of all providers wrote 12 prescriptions or less to Medicaid children. The following child characteristics were associated with inappropriate antibiotic prescribing: residence in a rural area (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.07–1.1), having a visit with an inappropriate prescriber (OR, 4.15; 95% CI, 4.1–4.2), age 0–2 years (OR, 1.39; 95% CI, 1.37–1.41), and presence of a chronic condition (OR, 1.31; 95% CI, 1.28–1.33).

Conclusions:

Inappropriate antibiotic prescribing to Kentucky Medicaid children is common. Provider and patient characteristics associated with inappropriate prescribing differ from those associated with higher volume. Claims data are useful to describe inappropriate use and could be a valuable metric for provider feedback reports. Policies are needed to support analysis and dissemination of antibiotic prescribing reports and should include all provider types and geographic areas.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 5 , May 2022 , pp. 582 - 588
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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