Dissecting the mechanisms of a 5-year decline in antibiotic prescribing

摘要: Abstract Importance The mechanisms driving the recent decline in outpatient antibiotic prescribing are unknown. Objective To estimate extent to which reductions number of prescriptions filled per visit (stewardship) and monthly rate visits (observed disease) for infectious disease conditions each contributed annual Massachusetts between 2011 2015. Design Outpatient medical pharmacy claims from All-Payer Claims Database were used rates 20 their contributions overall prescribing. Trends compared those National Ambulatory Medical Care Survey (NAMCS). Setting January September Participants 5,075,908 individuals with commercial health insurance or Medicaid under age 65 495,515 patients included NAMCS. Main outcomes measures avoided through observed per-visit condition. Results Between 2015, 1,000 declined by 18.9% July 13.6%. mean children 5 42.8% (95% CI 21.7%, 59.4%), principally reflecting reduced wintertime (p Conclusions relevance was driven a improved stewardship, contemporaneous reduction prompting antibiotics nationally. A focus on prevention should be considered alongside stewardship as means reduce Key points Question How did separate contribute 5-year 2011-2015? Findings In an observational analysis claims, probability both An estimated 358 over study period two mechanisms, 211 attributable 147 visit. Meaning Preventing need reducing