- Roughly a quarter of outpatient prescriptions filled in the United States in 2016 were inappropriate; 28.5% were not associated with a recent diagnostic code.
Why this matters
- Rates of inappropriate prescribing by US clinicians might be higher than previously believed, especially among adults.
- Familiarity with CDC prescribing guidelines for children, adults warranted.
- 19,203,264 enrollees (75.9% [14,571,944] adults, 24.1% [4,631,320] children, 51.7% [9,935,791] women).
- Mean 2.0 antibiotic prescriptions/user filled; most commonly azithromycin (19.0% [2,931,242]), amoxicillin (18.2% [2,818,939]), amoxicillin-clavulanate (11.6% [1,784,921]).
- Among 15,455,834 fills, 12.8% (1,973,873) were appropriate, 35.5% (5,487,003) potentially appropriate, 23.2% (3,592,183) inappropriate, 28.5% (4,402,775) not associated with recent diagnostic code.
- 99.8% (4,392,068) of unassociated fills were not associated with any claims.
- Most frequent diagnoses for inappropriate fills were acute bronchitis, acute upper respiratory tract infections, respiratory symptoms (cough).
- Of 11,053,059 fills classified as appropriate, potentially appropriate, or inappropriate, 74.7% (8,257,536) were prescribed in office-based settings, 6.2% (222,804) urgent care, 4.7% (168,396) emergency departments.
- Cross-sectional study evaluating appropriateness of outpatient antibiotic prescriptions among privately insured US children, nonelderly adults based on ICD-10 CM diagnostic codes.
- Funding: Agency for Healthcare Research and Quality.
- Misclassification bias.
- Out-of-pocket payments uncaptured.
- Prescribing based solely on indications.