variation in outpatient antibiotic use for acute respiratory infections in the veteran population....
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Variation in Outpatient Antibiotic use for Acute Respiratory Infections in the Veteran
Population.
Final Figures1, 2, 3, 4, 5, 6
Figure 1. Study Population.
All visits for acute respiratory infection at VA primary care clinics, emergency departments,
and urgent care clinics during study period 2005-2012
N=2,481,520
1,276,539 excluded for comorbidities•Cancers & Neoplasms (N= 259,863)•Diabetes (N=608,433)•COPD (N=806,897)•Others (N=30,728)
93,203 excluded for infections•Pneumonia (N=13,341)•Urinary tract (N=10,636)•Other infections (N=71,095)
N=2,388,317
N=1,111,778
Final Study PopulationN=1,044,523
N=1,036,982 without missing values
67,255 excluded for recent ARI in the past 30 days
Figure 2. Temporal trends in overall antibiotic use.
Figure 3. Temporal trends in the proportion of all antibiotics prescribed for each antibiotic class.
2005 2006 2007 2008 2009 2010 2011 20120%
10%
20%
30%
40%
50%
MacrolidesPenicillinsFluoroquinolonesOthers (Tetracyclines, Cephalosporins, Folate pathway inhibitors)
Pro
po
rtio
n o
f E
ac
h C
las
s o
f A
nti
bio
tic
Pre
sc
rib
ed
Figure 4. Predictors of antibiotic prescribing. '
Temperature
Number of comorbidities
Diagnosis
Distance to Clinic (Miles)
Patient Age
Sex
0.50 0.55 0.60 0.65 0.70 0.75 0.80 0.85 0.90
Adjusted Proportion
High fev er
Fev er
Normal
>=11
7-10
5-6
<=4
Other
Pharyngitis
Sinusitis
Bronchitis
URI
>31
12.3-31
5.3-12.3
<5.3
>68
61-68
49-61
<49
FemaleMale
'
Region
Location
Number ARI Visits Per Day
Time of Day
Setting
Prov ider Age
Prov ider Type
0.50 0.55 0.60 0.65 0.70 0.75 0.80 0.85 0.90
Adjusted Proportion
Northeast
South
Central
West
CBOCVAMC
>=42 - 3
1
Night
Late afternoon
Early afternoon
Late morning
Early morning
Urg. care clinicPrim. care clinic
ED
>=56.7
50.1-56.7
42-50.1
<42
Other
Nurse
Mid-lev el
Physicians
Figure 5. Predictors of macrolide prescribing. '
Temperature
Number of comorbidities
Diagnosis
Distance to Clinic (Miles)
Patient Age
Sex
0.20 0.25 0.30 0.35 0.40 0.45 0.50 0.55 0.60
Adjusted Proportion
High fev er
Fev er
Normal
>=11
7-10
5-6
<=4
Other
Pharyngitis
Sinusitis
Bronchitis
URI
>31
12.3-31
5.3-12.3
<5.3
>68
61-68
49-61
<49
FemaleMale
'
Region
Location
Number ARI Visits Per Day
Time of Day
Setting
Prov ider Age
Prov ider Type
0.20 0.25 0.30 0.35 0.40 0.45 0.50 0.55 0.60
Adjusted Proportion
Northeast
South
Central
West
CBOCVAMC
>=42 - 3
1
Night
Late afternoon
Early afternoon
Late morning
Early morning
Urg. care clinicPrim. care clinic
ED
>=56.7
50.1-56.7
42-50.1
<42
Other
Nurse
Mid-lev el
Physicians
Figure 6a. Provider variation in antibiotic prescribing.
Figure 6b. Sources of variation in antibiotic prescribing.
Appendix B Figure. Conditional distribution of antibiotic prescribing.
VAMCs at 10th Percentile
VAMCs at 90th Percentile
VAMCs at 50th Percentile