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Wattles BA, Vidwan NK, Feygin Y, et al. Antibiotic prescribing to Kentucky Medicaid children, 2012-2017: Prescribing is higher in rural areas. J Rural Health. 2021;doi: 10.1111/jrh.12584.
Wattles, B. A., Vidwan, N. K., Feygin, Y., Jawad, K. S., Creel, L. M., & Smith, M. J. (2021). Antibiotic prescribing to Kentucky Medicaid children, 2012-2017: Prescribing is higher in rural areas. The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, . https://doi.org/10.1111/jrh.12584
Wattles, Bethany A, et al. "Antibiotic prescribing to Kentucky Medicaid children, 2012-2017: Prescribing is higher in rural areas." The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association vol. (2021). doi: https://doi.org/10.1111/jrh.12584
Wattles BA, Vidwan NK, Feygin Y, Jawad KS, Creel LM, Smith MJ. Antibiotic prescribing to Kentucky Medicaid children, 2012-2017: Prescribing is higher in rural areas. J Rural Health. 2021 May 12; doi: 10.1111/jrh.12584. Epub 2021 May 12. PMID: 33978987.
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J Rural Health. 2021 May 12; doi: 10.1111/jrh.12584. Epub 2021 May 12.

Antibiotic prescribing to Kentucky Medicaid children, 2012-2017: Prescribing is higher in rural areas.

The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association

Bethany A Wattles, Navjyot K Vidwan, Yana Feygin, Kahir S Jawad, Liza M Creel, Michael J Smith

Affiliations

  1. Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky, USA.
  2. Norton Children's and University of Louisville School of Medicine, Louisville, Kentucky, USA.
  3. School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky, USA.
  4. Duke University Medical Center, Pediatric Infectious Diseases, Durham, North Carolina, USA.

PMID: 33978987 DOI: 10.1111/jrh.12584

Abstract

PURPOSE: Antibiotic resistance is a major public health threat. Antibiotic use is the main driver of resistance, with children and the state of Kentucky having particularly high rates of outpatient antibiotic prescribing. The purpose of this study was to describe patient and provider characteristics associated with pediatric antibiotic use in Kentucky Medicaid children.

METHODS: We used Medicaid prescription claims data from 2012 to 2017 to describe patterns of pediatric antibiotic receipt in Kentucky. Patient and provider variables were analyzed to identify variations in prescribing.

FINDINGS: Children who were female, less than 2 years old, White, and living in a rural area had consistently higher rates of antibiotic prescriptions. There was significant geographic variability in prescribing, with children in Eastern Kentucky receiving more than 3 courses of antibiotics a year. Most antibiotic prescriptions for children were written by general practitioners and nurse practitioners rather than pediatricians.

CONCLUSION: These findings support the need for extensive antibiotic stewardship efforts inclusive of rural outpatient practices.

© 2021 National Rural Health Association.

Keywords: Medicaid; antibiotic stewardship; antibiotic use; health services research; rural children

References

  1. Centers for Disease Control and Prevention (CDC). Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: US Department of Health and Human Services, CDC; 2019. - PubMed
  2. Fleming-Dutra KE, Hersh AL, Shapiro DJ, et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011. JAMA. 2016;315(17):1864-1873. - PubMed
  3. CDC. Measuring Outpatient Antibiotic Prescribing. 2018. Available at: https://www.cdc.gov/antibiotic-use/community/programs-measurement/measuring-antibiotic-prescribing.html. Accessed August 5, 2020. - PubMed
  4. King LM, Bartoces M, Fleming-Dutra KE, Roberts RM, Hicks LA. Changes in US outpatient antibiotic prescriptions from 2011-2016. Clin Infect Dis. 2020;70(3):370-377. - PubMed
  5. Sanchez GV, Fleming-Dutra KE, Roberts RM, Hicks LA. Core elements of outpatient antibiotic stewardship. MMWR Recomm Rep. 2016;65(6):1-12. - PubMed
  6. Zetts RM, Garcia AM, Doctor JN, Gerber JS, Linder JA, Hyun DY. Primary care physicians’ attitudes and perceptions towards antibiotic resistance and antibiotic stewardship: a national survey. Open Forum Infect Dis. 2020;7(7):ofaa224. - PubMed
  7. Cummings PL, Alajajian R, May LS, et al. Utilizing behavioral science to improve antibiotic prescribing in rural urgent care settings. Open Forum Infect Dis. 2020;7(7):ofaa174. - PubMed
  8. Chiswell E, Hampton D, Okoli CT. Effect of patient and provider education on antibiotic overuse for respiratory tract infections. J Healthcare Qual. 2019;41(3):e13-20. - PubMed
  9. US Department of Agriculture (USDA). Economic Research Service. Rural-Urban Continuum Codes. 2013. Available at: https://www.ers.usda.gov/data-products/rural-urban-continuum-codes.aspx. Accessed September 30, 2020. - PubMed
  10. Kaiser Family Foundation (KFF). Health Insurance Coverage of Children 0-18. Available at: https://www.kff.org/other/state-indicator/children-0-18/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D. Accessed December 14, 2020. - PubMed
  11. Hoadley J, Alker J, Holmes M. Health Insurance Coverage in Small Towns and Rural America: the Role of Medicaid Expansion. 2018. Available at: https://ccf.georgetown.edu/wp-content/uploads/2018/09/FINALHealthInsuranceCoverage_Rural_2018.pdf. Accessed January 8, 2021. - PubMed
  12. Hicks LA, Bartoces MG, Roberts RM, et al. US outpatient antibiotic prescribing variation according to geography, patient population, and provider specialty in 2011. Clin Infect Dis. 2015;60(9):1308-1316. - PubMed
  13. CDC. Outpatient Antibiotic Prescriptions - United States. 2017. Available at: https://www.cdc.gov/antibiotic-use/community/programs-measurement/state-local-activities/outpatient-antibiotic-prescriptions-US-2017.html. Accessed July 28, 2020. - PubMed
  14. Gerber JS, Prasad PA, Localio AR, et al. Racial differences in antibiotic prescribing by primary care pediatricians. Pediatrics. 2013;131(4):677-684. - PubMed
  15. Goyal MK, Johnson TJ, Chamberlain JM, et al. Racial and ethnic differences in antibiotic use for viral illness in emergency departments. Pediatrics. 2017;140(4):e20170203. - PubMed
  16. Wattles B, Vidwan N, Ghosal S, et al. Cefdinir use in the Kentucky Medicaid Population: a priority for outpatient antimicrobial stewardship. J Pediatric Infect Dis Soc. 2021;10(2):157-160. - PubMed
  17. Watson JR, Wang L, Klima J, et al. Healthcare claims data: an underutilized tool for pediatric outpatient antimicrobial stewardship. Clin Infect Dis. 2017;64(11):1479-1485. - PubMed
  18. Katz SE, Staub M, Ouedraogo Y, et al. Population-based assessment of patient and provider characteristics influencing pediatric outpatient antibiotic use in a high antibiotic-prescribing state. Infect Control Hosp Epidemiol. 2020;41(3):331-336. - PubMed
  19. Yates TD, Davis ME, Taylor YJ, et al. Not a magic pill: a qualitative exploration of provider perspectives on antibiotic prescribing in the outpatient setting. BMC Fam Pract. 2018;19(1):96. - PubMed
  20. Kohut MR, Keller SC, Linder JA, et al. The inconvincible patient: how clinicians perceive demand for antibiotics in the outpatient setting. Fam Pract. 2020;37(2):276-282. - PubMed
  21. Barnes H, Richards MR, McHugh MD, Martsolf G. Rural and nonrural primary care physician practices increasingly rely on nurse practitioners. Health Affairs. 2018;37(6):908-914. - PubMed
  22. Xue Y, Smith JA, Spetz J. Primary care nurse practitioners and physicians in low-income and rural areas, 2010-2016. JAMA. 2019;321(1):102-105. - PubMed
  23. Fleming-Dutra KE, Bartoces M, Roberts RM, Hicks LA. Characteristics of primary care physicians associated with high outpatient antibiotic prescribing volume. Open Forum Infect Dis. 2018;5(1):ofx279. - PubMed
  24. The Joint Commission. Antimicrobial Stewardship in Ambulatory Health Care. R3 Report. 2019. Available at: https://www.jointcommission.org/-/media/tjc/documents/standards/r3-reports/r3_23_antimicrobial_stewardship_amb_6_14_19_final2.pdf?db=web&hash=81604D26AD039EA9ABBFBBA8907F8430. Accessed September 30, 2020. - PubMed
  25. Gerber JS, Prasad PA, Fiks AG, et al. Effect of an outpatient antimicrobial stewardship intervention on broad-spectrum antibiotic prescribing by primary care pediatricians: a randomized trial. JAMA. 2013;309(22):2345-2352. - PubMed
  26. Meeker D, Linder JA, Fox CR, et al. Effect of behavioral interventions on inappropriate antibiotic prescribing among primary care practices: a randomized clinical trial. JAMA. 2016;315(6):562-570. - PubMed

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