Monday, March 27, 2023
| Characteristics | Higher-volume prescribers (top 10%) | Lower-volume prescribers (lower 90%) | Total prescribers§ | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Prescribers (n = 69,835) |
Prescriptions (n = 24.4 million) |
Prescriptions per 1,000 beneficiaries | Prescribers (n = 627,230) |
Prescriptions (n = 35.0 million) |
Prescriptions per 1,000 beneficiaries | Prescribers (N = 697,065) |
Prescriptions (N = 59.4 million) |
Prescriptions per 1,000 beneficiaries | ||
| No. (%) | No. (%) | Median (IQR) | No. (%) | No. (%) | Median (IQR) | No. (%) | No. (%) | Median (IQR) | ||
| U.S. Census Bureau region¶ | ||||||||||
| South | 33,571 (48.1) | 12,277,664 (50.3) | 696 (516–925) | 217,854 (34.7) | 12,800,940 (36.6) | 434 (250–714) | 251,425 (36.1) | 25,078,604 (42.2) | 471 (277–765) | |
| Midwest | 15,096 (21.6) | 5,163,003 (21.2) | 681 (507–912) | 141,561 (22.6) | 8,110,378 (23.2) | 435 (260–714) | 156,657 (22.5) | 13,273,381 (22.4) | 461 (278–750) | |
| Northeast | 11,188 (16.0) | 3,715,665 (15.2) | 655 (472–893) | 129,416 (20.6) | 6,802,148 (19.4) | 410 (224–708) | 140,604 (20.2) | 10,517,813 (17.7) | 432 (238–736) | |
| West | 9,980 (14.3) | 3,241,995 (13.3) | 649 (467–879) | 138,399 (22.1) | 7,270,835 (20.8) | 419 (230–731) | 148,379 (21.3) | 10,512,830 (17.7) | 436 (240–750) | |
| Specialty | ||||||||||
| Family practice | 19,213 (27.5) | 6,815,010 (27.9) | 611 (463–796) | 70,546 (11.2) | 5,341,667 (15.3) | 303 (201–455) | 89,759 (12.9) | 12,156,677 (20.5) | 358 (225–553) | |
| Internal medicine | 17,185 (24.6) | 6,476,428 (26.5) | 590 (429–816) | 68,257 (10.9) | 4,716,606 (13.5) | 333 (209–477) | 85,442 (12.3) | 11,193,034 (18.8) | 375 (237–545) | |
| Nurse practitioner | 9,857 (14.1) | 2,920,894 (12.0) | 711 (553–866) | 98,182 (15.7) | 5,934,913 (17.0) | 398 (244–587) | 108,039 (15.5) | 8,855,807 (14.9) | 425 (258–625) | |
| Urology | 4,738 (6.8) | 2,020,285 (8.3) | 760 (603–961) | 4,687 (0.7) | 426,424 (1.2) | 500 (370–660) | 9,425 (1.4) | 2,446,709 (4.1) | 632 (462–839) | |
| Physician assistant | 5,200 (7.4) | 1,553,698 (6.4) | 686 (537–816) | 61,273 (9.8) | 3,634,949 (10.4) | 407 (251–567) | 66,473 (9.5) | 5,188,647 (8.7) | 427 (265–594) | |
| Dentist | 2,063 (3.0) | 552,858 (2.3) | 1,271 (1,122–1,450) | 110,629 (17.6) | 5,004,506 (14.3) | 1,068 (914–1,222) | 112,692 (16.2) | 5,557,364 (9.4) | 1,071 (917–1,228) | |
| Other** | 11,579 (16.6) | 4,059,154 (16.6) | 850 (583–1,239) | 213,656 (34.1) | 9,925,236 (28.4) | 360 (188–533) | 225,235 (32.3) | 13,984,390 (23.5) | 375 (197–560) | |
TABLE. Number of antibiotic prescribers, number of outpatient antibiotic prescriptions, and prescribing rate per 1,000 beneficiaries* among higher-volume prescribers and lower-volume prescribers,† by U.S. Census Bureau region and specialty — United States, 2019
Abbreviation: CMS = Centers for Medicare & Medicaid Services.* CMS Part D Prescribers by Provider data set, 2019.
† Higher-volume prescribers are the top 10% of prescribers by antibiotic volume; lower-volume prescribers are the lower 90% of prescribers by antibiotic volume.
§ Total number of prescribers includes prescribers with ≥11 antibiotic prescription drug events filled at their direction by Medicare Part D beneficiaries during 2019.
¶ U.S. Census Bureau regions: Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont. Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin. South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia. West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming.
** “Other” includes the remaining provider specialties in the CMS Part D Prescribers by Provider data set. The top six prescriber specialties with the largest number of prescribers in the highest 10th percentile by antibiotic prescription volume are represented.
Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™
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Nurses - 0.25 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)
Pharmacists - 0.25 Knowledge-based ACPE (0.025 CEUs)
This activity is intended for public health officials, pharmacists, internists, infectious disease clinicians, family practitioners, advanced practice nurses, pharmacists and other clinicians involved in antibiotic prescribing and stewardship.
The goal of this activity is to describe higher-volume antibiotic prescribers (the highest 10% of prescribers by antibiotics volume) in outpatient settings compared with lower-volume prescribers (the lower 90% of prescribers by antibiotic volume), according to an analysis of 2019 data from the Centers for Medicare & Medicaid Services (CMS) Part D Prescriber Public Use Files regarding prescriber-level antibiotic prescriptions among healthcare providers in the United States who distributed ≥ 11 antibiotic prescriptions.
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Antibiotic prescribing can lead to adverse drug events and antibiotic resistance, which pose ongoing urgent public health threats [1]. Adults aged ≥65 years (older adults) are recipients of the highest rates of outpatient antibiotic prescribing and are at increased risk for antibiotic-related adverse events, including Clostridioides difficile and antibiotic-resistant infections and related deaths [1]. Variation in antibiotic prescribing quality is primarily driven by prescribing patterns of individual health care providers, independent of patients’ underlying comorbidities and diagnoses [2]. Engaging higher-volume prescribers (the top 10% of prescribers by antibiotic volume) in antibiotic stewardship interventions, such as peer comparison audit and feedback in which health care providers receive data on their prescribing performance compared with that of other health care providers, has been effective in reducing antibiotic prescribing in outpatient settings and can be implemented on a large scale [3–5]. This study analyzed data from the Centers for Medicare & Medicaid Services (CMS) Part D Prescriber Public Use Files (PUFs)* to describe higher-volume antibiotic prescribers in outpatient settings compared with lower-volume prescribers (the lower 90% of prescribers by antibiotic volume). Among the 59.4 million antibiotic prescriptions during 2019, 41% (24.4 million) were prescribed by the top 10% of prescribers (69,835). The antibiotic prescribing rate of these higher-volume prescribers (680 prescriptions per 1,000 beneficiaries) was 60% higher than that of lower-volume prescribers (426 prescriptions per 1,000 beneficiaries). Identifying health care providers responsible for a higher volume of antibiotic prescribing could provide a basis for additional assessment of appropriateness and outreach. Public health organizations and health care systems can use publicly available data to guide focused interventions to optimize antibiotic prescribing to limit the emergence of antibiotic resistance and improve patient outcomes.
