Researchers at the Center for Disease Dynamics, Economics and Policy have identified key patterns in antibiotic prescription rates in the United States related to physician density, according to a paper published in the Journal of Antimicrobial Chemotherapy.
The study’s authors set out to investigate how changes in and peculiarities of the US healthcare system – in particular the explosion in popularity of urgent care and retail clinics between 2000 and 2010 – affect prescribing rates. Understanding how these prescriptions change is a critical component of targeting the inappropriate and unnecessary antibiotic prescriptions that are driving the rise of antibiotic-resistant bacteria worldwide.
In poorer areas in the US, adding these clinics and retail centers achieved an intended effect of increasing access; clinics would make overall prescription rates increase but individual physician prescription rates remained stable.
In wealthier areas, however, they found that a clinic actually increased the rate of prescribing by physicians. Evidence has shown that when clinics enter such an area, physician offices change their operations, creating more walk-in slots and same-day appointments. These “competitive” actions increase the opportunities for people to access the physician and thus drive up the rate of prescribing.
Eili Klein, the paper’s lead author, said the study has important implications for policy.
“A quantitative relationship between prescribing and its drivers can help predict the changes in antibiotic consumption that will result from future changes in demographics and socioeconomic characteristics,” said Klein. “It also enables predictions of changes in prescribing practices as a result of specific interventions that target the healthcare delivery system.”
Competition between healthcare providers and physician density may indeed be driving up antibiotic prescriptions, and physicians may find themselves subject to market forces like many other professions.
“Our results serve as a reminder that healthcare is a business, and competition among providers (whether it be other physicians or clinics) may influence prescribing habits,” said Klein.
This work was supported by The Models of Infectious Disease Agent Study (MIDAS) awarded by the National Institutes of General Medical Sciences at the National Institutes of Health (U54 GM088491) and The Extending the Cure Project funded by a Pioneer Portfolio grant of the Robert Wood Johnson Foundation. The funders had no role in the design and conduct of the study, the collection, management, analysis and interpretation of the data, or the preparation, review and approval of the manuscript.
Influence of provider and urgent care density across different socioeconomic strata on outpatient antibiotic prescribing in the USA, Eili Y. Klein, Michael Makowsky, Megan Orlando, Erez Hatna, Nikolay P. Braykov and Ramanan Laxminarayan, Journal of Antimicrobial Chemotherapy, doi: 10.1093/jac/dku563, published online 20 January 2015.