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Measuring Outpatient Antibiotic Prescribing

Research is regularly conducted to analyze national and state prescribing data in order to better understand trends in outpatient antibiotic prescribing and to identify where interventions to improve prescribing are most needed. By measuring prescribing, we can compare performance across health plans, states, and other entities. Decision-makers can use this information to guide policy interventions.

Key U.S. Statistics

Below are a number of statistics that help describe how antibiotics are currently being prescribed in outpatient settings in the United States and how these practices are contributing to the larger issue of antibiotic resistance.

Community Antibiotic Prescribing Rates by State (2013/2014)
Click to view antibiotic prescribing rates for U.S. health provider offices (2013/2014)

  • Approximately 50% of antibiotic prescriptions written in the outpatient setting may be inappropriate.1,2,3
  • In one year, 262.5 million courses of antibiotics are written in the outpatient setting. This equates to more than 5 prescriptions written each year for every 6 people in the United States.4
  • Antibiotic prescribing in the outpatient setting varies by state.4
  • Local outpatient prescribing practices contribute to local resistance patterns.5
  • Outpatient antibiotic prescribing is greatest in the winter months.6
  • The majority of antibiotic expenditures are associated with the outpatient setting.7
  • Azithromycin and amoxicillin are among the most commonly prescribed antibiotics.4

Outpatient Antibiotic Prescription Report by Year

View outpatient antibiotic prescriptions by year from IMS Health data and US Census files.

Data Sources

There are several datasets that can be used to measure outpatient antibiotic prescribing:

  • Healthcare Effectiveness Data and Information Set (HEDIS)
  • National Ambulatory Medical Care Survey (NAMCS)
  • National Hospital Ambulatory Medical Care Survey (NHAMCS)
  • Proprietary datasets from third party vendors

Healthcare Effectiveness Data and Information Set

HEDIS is a performance measurement tool used by over 90% of the nation’s health plans. HEDIS makes it possible to compare the performance of health plans. CDC and the National Committee on Quality Assurance have written 4 HEDIS measures related to antibiotic use in outpatient settings.

The pediatric measures, which were incorporated into HEDIS in 2004, are

  • Appropriate testing for children with pharyngitis: percentage of children 2 to 18 years of age who were diagnosed with pharyngitis, prescribed an antibiotic and received a group A Streptococcus (strep) test for the episode
  • Appropriate treatment for children with upper respiratory infection (URI): percent of children 3 months to 18 years of age with a diagnosis of URI who were not prescribed antibiotics on or three days after the episode date

The adult measures, which were incorporated into HEDIS in 2006 and 2008 respectively, are

  • Avoidance of antibiotic treatment in adults with acute bronchitis (inverted the measure rate and renamed measure for 2008): percent of adults diagnosed with acute bronchitis who were not dispensed an antibiotic prescription
  • Antibiotic utilization: This measure summarizes data on outpatient utilization of drug prescriptions, stratified by age, and evaluates many factors, including total number of antibiotic prescriptions, average number of prescriptions per year, and use of antibiotics of concern

Learn more about HEDIS

National Ambulatory Medical Care Survey

NAMCS is a national survey designed to meet the need for objective, reliable information about the provision and use of ambulatory medical care services in the United States. Findings are based on a sample of visits to non-federal employed office-based physicians who are primarily engaged in direct patient care.

Learn more about NAMCS

National Hospital Ambulatory Medical Care Survey

NHAMCS is designed to collect data on the utilization and provision of ambulatory care services in hospital emergency and outpatient departments. Findings are based on a national sample of visits to the emergency departments and outpatient departments of noninstitutional general and short-stay hospitals.

Learn more about NHAMCS

Proprietary Datasets

Third party vendors collect healthcare data on diseases, treatment, costs, and outcomes, including data related to outpatient antibiotic prescribing. Proprietary data can be used to characterize antibiotic prescribing practices.

Healthy People 2020

Healthy People provides science-based, 10-year national objectives for improving the health of all Americans. There are 2 objectives included in the 2020 plan that relate to antibiotic use:

  • Reduce the number of courses of antibiotics for ear infections for young children (IID-5)
  • Reduce the number of courses of antibiotics prescribed for the sole diagnosis of the common cold (IID-6)

Footnotes

  1. Centers for Disease Control and Prevention (CDC). Office-related antibiotic prescribing for persons aged ≤14 years --- United States, 1993—1994 to 2007—2008. MMWR Morb Mortal Wkly Rep. 2011;60(34):1153-6.
  2. Pichichero ME. Dynamics of antibiotic prescribing for children. JAMA. June 19, 2002;287(23):3133-5.
  3. Shapiro DJ, Hicks LA, Pavia AT, Hersh AL. Antibiotic prescribing for adults in ambulatory care in the USA, 2007–09. J Antimicrob Chemother. 2014;69(1):234-40.
  4. Hicks LA, Bartoces MG, Roberts RM, Suda KJ, Hunkler RJ, Taylor TH, Schrag SJ. U.S. outpatient antibiotic prescribing variation according to geography, patient population, and provider specialty in 2011. Clin Infect Dis. 2015 Mar 5. Epub ahead of print.
  5. Hicks LA, Chien YW, Taylor TH Jr, Haber M, Klugman KP; Active Bacterial Core surveillance (ABCs) Team. Outpatient antibiotic prescribing and nonsusceptible Streptococcus pneumoniae in the United States, 1996-2003. Clin Infect Dis. 2011;53(7):631-9.
  6. Suda KJ, Hicks LA, Roberts RM, Hunkler RJ, Taylor TH. Trends and seasonal variation in outpatient antibiotic prescription rates in the United States, 2006 to 2010. Antimicrob Agents Chemother. 2014;58(5):2763-6.
  7. Suda KJ, Hicks LA, Roberts RM, Hunkler RJ, Danziger LH. A national evaluation of antibiotic expenditures by healthcare setting in the United States, 2009. J Antimicrob Chemother. 2013;68:715-8

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