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Physicians who are high-prescribers of antibiotics may be high-prescribers of several other medications

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Doctors who are high-intensity antibiotic prescribers are more likely to initiate and continue the prescribing of opioids, benzodiazepines and proton-pump inhibitors in nursing homes, according to researchers at ICES, a non-profit research institute that uses population-based health information to produce knowledge on a broad range of health care issues.

The study, published today in the Journal of General Internal Medicine, found that high-intensity antibiotic prescribers were up to 38 per cent more likely to prescribe benzodiazepines, opioids and proton-pump inhibitors compared to average-intensity antibiotic prescribers, and up to 26 per cent more likely to newly prescribe these medications.

“Our findings show a strong association between physician prescribing of episodic medications, such as antibiotics, and prescribing patterns for multiple medications used for longer terms. This suggests that rates of episodic prescribing may be a useful screening mechanism to identify physicians who might benefit more broadly from interventions on appropriate prescribing,” says Susan Bronskill, senior author on the study and senior scientist at ICES.

The researchers also found that high-intensity antibiotic prescribers were approximately six times more likely to prescribe all three medications concurrently, compared to average-intensity antibiotic prescribers.

“Physicians who are high-prescribers of an individual medication may be a high-prescriber of all medications. Not only do they prescribe potentially high-risk medications to their patients, we also found that high-intensity antibiotic prescribers were up to 23 per cent more likely to prescribe levothyroxine and beta-blocker ophthalmic drops, which was unexpected,” says Dr. Kieran Quinn, the lead author of the study, a physician at Sinai Health System and an ICES student.

The researchers looked at opioids, benzodiazepines and proton-pump inhibitors because they are commonly prescribed medications that are associated with risks of fall, fracture and death in older adults. The study included the data on 1,926 physicians who provided care to 128,979 nursing home patients in 2015.

The researchers add that strategies that target high-volume prescribers of single medication classes appear to be effective in reducing prescribing of those single medications. However, this study is one of the first to highlight a similar initiative to the prescribing of multiple medication classes – a strategy that may be more efficient to modify prescribing practices in large health systems.

The study “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,” was published in Journal of General Internal Medicine.


Author block: Kieran L. Quinn, Michael A. Campitelli, Christina Diong, Nick Daneman, Nathan M. Stall, Andrew M. Morris, Allan S. Detsky, Lianne Jeffs, Colleen J Maxwell, Chaim M. Bell and Susan E. Bronskill
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ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario

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