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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


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.



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.

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