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Association between physician intensity of antibiotic prescribing and the prescription of benzodiazepines, opioids and proton-pump inhibitors to nursing home residents: a population-based observational study

Quinn KL, Campitelli MA, Diong C, Daneman N, Stall NM, Morris AM, Detsky AS, Jeffs L, Maxwell CJ, Bell CM, Bronskill SE. J Gen Intern Med. 2019; 34(12):2763-71. Epub 2019 Oct 1. DOI: 10.1007/s11606-019-05333-8.

Background — Prescribing patterns for episodic medications, such as antibiotics, might make useful surrogate measures of a physician’s overall prescribing practice because use is common, and variation exists across prescribers. However, the extent to which a physician’s current antibiotic prescribing practices are associated with the rate of prescription of other potentially harmful medications remains unknown.

Objective — To examine the association between a physician’s rate of antibiotic prescribing and their prescribing rate of benzodiazepines, opioids and proton-pump inhibitors in older adults.

Design Population-based, cohort study in nursing homes in Ontario, Canada, which provides comprehensive clinical, behavioural and functional information on all patients.

Participants — 1,926 physicians who provided care among 128,979 physician-patient pairs in 2015.

Main Measures — Likelihood of prescribing a benzodiazepine, opioid or proton-pump inhibitor between low-, average- and high-intensity antibiotic prescribers, adjusted for patient characteristics.

Key Results — Compared to average-intensity antibiotic prescribers, high-intensity prescribers had an increased likelihood of prescribing a benzodiazepine (odds ratio 1.21 [95% CI, 1.11-1.32]), an opioid (odds ratio 1.28 [95% CI, 1.17-1.39]), or a proton-pump inhibitor (odds ratio 1.38 [95% CI, 1.27-1.51]). High-intensity antibiotic prescribers were more likely to be high prescribers of all three medications (odds ratio 6.24 [95% CI, 2.90-13.39]) and also more likely to initiate all three medications, compared to average-intensity prescribers.

Conclusions — The intensity of a physician’s episodic antibiotic prescribing was significantly associated with the likelihood of new and continued prescribing of opioids, benzodiazepines and proton-pump inhibitors in nursing homes. Patterns of episodic prescribing may be a useful mechanism to target physician-level interventions to optimize general prescribing behaviors, instead of prescribing behaviors for single medications.