A study of emergency and family medicine providers in Washington state found an association between high antibiotic and high opioid prescribing rates, researchers reported today in Open Forum Infectious Diseases.
Using data from the Centers for Medicare & Medicaid Services Medicare Part D (MPD) program for 2021, researchers from the Washington State Department of Health looked at outpatient prescriptions at the prescriber level for three categories of drugs (antibiotics, antipsychotics, and opioids) and provider details such as provider type, sex, and practice location. They defined high prescribing behavior as a prescribing rate greater than or equal to the 90th percentile of their specialty and used multivariate logistic regression to determine associations between high antibiotic and high opioid prescribers.
A total of 2,766 family and emergency medicine physicians prescribed both opioids and antibiotics to MPD beneficiaries in 2021. The median prescribing rate for antibiotics was 212 antibiotic claims per 1,000 beneficiaries, and the median prescribing rate for opioids was 328 opioid claims per 1,000 beneficiaries. Three hundred and eight physicians (11%) were identified as high prescribers of antibiotics, and 244 physicians (9%) were identified as high prescribers of opioids.
After adjustment for physician age and sex, the overall odds of being a high antibiotic prescriber were 2.91 times (95% confidence interval [CI], 2.10 to 4.0) greater among physicians who were also high prescribers of opioids, and the odds of being a high opioid prescriber were 2.90 times (95% CI, 2.09 to 3.09) greater among physicians who were high antibiotic prescribers. The researchers also found that the odds of being a high prescriber of both medications increased with the age of the physician.
The authors of the study say the findings suggest that high prescribing of medications is a provider behavior, and that opioid and antimicrobial stewards should collaborate on shared goals.
"Opportunities exist for stewards in both disciplines to learn from each other such as uptake of clinical decision support tools to optimize prescribing, shorter drug durations for acute conditions, optimizing discharge prescribing, and communication strategies regarding benefits and risks of drugs and contingency planning," they wrote.