2093. Prescribing of Antibiotics by Provider Type Across the Veterans Health Administration (VHA), 2015–2017

Abstract

BackgroundAntibiotic stewardship frequently targets high prescribing providers. Our objective was to determine differences by provider type in antibiotic prescribing rates, high prescribing and trends over time.MethodsCross-sectional study in 2015–2017 of non-trainee dental and medical providers actively practicing (defined as ≥20 VHA visits). Medical providers included all physicians and advanced practice providers (APP). Antibiotics prescribed within 7 days of a visit were included. “High prescribing” was defined as providers with visit-based rates ≥75th percentile. Chi square assessed differences in the frequency of high prescribing. Poisson and logistic regression were applied; models were clustered within the facility.ResultsAt 130 VHA facilities, there were 32,000 unique medical providers and 1300 dentists actively practicing/year. From 2015–2017, overall antibiotic prescribing rates decreased by 6.4% (P < 0.0001 for trend); decreasing by 1.8% for dentists (P < 0.001) and 6.6% for all medical providers (P < 0.001). More antibiotics were prescribed/visit among dentists vs. medical providers (6.7 vs. 4.3/100 visits; IRR = 1.7). Among medical providers, APP had higher rates (5.0 vs. 4.1/100 visits; P < 0.001). Among dentists, specialty dentists had higher rates compared with general dentists (7.6 vs. 6.5/100 visits; P < 0.001), increasing by 1.9% for specialty dentists and decreasing by 3.1% for general dentists. At the facility-level, dentists who were high prescribers (≥ 75th percentile) of antibiotics were at different facilities as medical providers who were high prescribers (P < 0.001). However, there was no difference in the odds of being a high antibiotic prescriber for dentists when compared with medical providers. Specialty dentists (OR = 1.7; 95% CI: 1.4–2.1) had higher odds of being high prescribers when compared with general dentists. There was no difference among the type of medical provider.ConclusionAs compared with physicians, dentists and APP have higher antibiotic prescribing rates, though prescribing may differ based on the frequency of infection-related visits. Facility-level interventions to curb the high use of antibiotics may not be reaching high prescribing dentists. Stewardship should be targeted to non-physician providers.Disclosures All authors: No reported disclosures.