Physician Prescribing Research Articles

Respiratory Therapy Leaders' Perceptions of Value of Respiratory Care Services.

Respiratory care departments are experiencing an increased need to demonstrate value in the care they deliver. Value efficiency is a concept that incorporates the value of individual treatments into the normal operations of a department. The purpose of this study was to describe respiratory care leaders' attitudes about the value of services provided by respiratory care departments. An electronic survey was distributed via social media, professional networks, and a manager work group. The survey was targeted to directors, managers, and supervisors of respiratory care departments. We asked questions related to value, services, and barriers to implementation of value efficiency. Data analysis was descriptive. We received 116 responses; 86% were from managers or directors. The 5 most valuable services delivered were invasive mechanical ventilation (82%), noninvasive ventilation or CPAP (71%), protocol-driven care (47%), code team (44%), and rapid response team (41%). The 5 least valuable services delivered by respiratory care departments were electrocardiograms (63%), stress testing (44%), lung expansion therapies (41%), sleep studies staffed by the respiratory care department (36%), and smoking cessation education (36%). The primary barrier to value efficiency was physician prescribing practices (68%). There was general agreement that physicians support respiratory therapy protocols (71%), value should be considered when evaluating respiratory care services (95%), and directing resources to more valuable services if possible (73%). Respondents did not agree that hospital administrators understand respiratory therapy workflow and full-time equivalent needs (35%) nor that hospital administrators would be supportive if we reduced services (18%). In a small sample of respiratory therapy leaders, there was limited consensus on what respiratory care services are the most and least valuable. Lack of consensus on high- and low-value services and physician prescribing practice were the primary barriers to value efficiency. Nearly all respondents felt value should be considered when evaluating respiratory care services.

Physician's prescription and pharmaceutical industry's influence - where have the ethics gone?

The relationship between physicians and the pharmaceutical industry has evolved significantly over the years, raising concerns about ethical practices in medical prescribing. This article explores the multifaceted influence of pharmaceutical companies on physician behaviour, highlighting how marketing strategies, financial incentives, and promotional activities can compromise the integrity of clinical decision-making. Through a comprehensive review of the literature, the article examines the implications of inculcating ethics in undergraduate medical programmes, so future healthcare professionals understand the importance of making evidence-based decisions. Furthermore, this article calls for a critical evaluation of existing regulatory frameworks and advocates for stronger ethical guidelines to ensure that physician prescriptions are based solely on patient needs rather than external pressures from the pharmaceutical industry. Ultimately, it emphasizes the importance of restoring ethical standards in medicine to safeguard patient welfare and maintain the sanctity of the physician-patient relationship. Keywords: Physician’s prescription, pharmaceutical industry, Ethics.

Prescription ethics in a low-middle income country: Thematic analysis of research from Pakistan

The ethics of physician prescriptions is a matter of globalconcern. While commonalities exist in reasons forunethical prescribing practices such as physicianincentivization by pharmaceutical companies, theunderlying social determinants may be different acrosscountries and socioeconomic strata. This scoping reviewhas collected themes from publications aroundprescription ethics from Pakistan. Four major themeswere identified: 1) Impact – including physical andfinancial harm to patients, deficit in trust anddevelopment of antibiotic resistance, 2) Causes –including personal financial needs, peer pressure,inadequacy of education in ethics and professionalism,lack of evidence for policy-making, and weak regulatoryframework, 3) Type – includes unethical practices likeexcessive, inappropriate/unnecessary, expensive, nonevidence-based, and off-label prescriptions, andprescription of controlled drugs to addicts, and 4)Solution – proposed strategies to curb unethicalprescribing practices included education of communityand undergraduates, trainees and practicing physicians,improvement in policies/laws on drugdispensation/prescriptions, their enforcement andaccountability, as well as making health care accessible. Insummary, this review identifies various socialdeterminants of prescription ethics in the context ofPakistan, a low-middle income country, and highlightslocally applicable measures to prevent unethicalprescribing practices. Keywords: Ethics, prescriptions, incentive-linked,inducement, enticement, incentivization, Pakistan

Moral hazard in physician prescribing behavior: evidence from China’s Zero-Markup Policy

ABSTRACT In this study, we investigate the moral hazard associated with physician prescription patterns in the context of China’s Zero-Markup Policy (ZMP), which annuls markups on Western medications while exempting Traditional Chinese Medicine (TCM). Using a distinctive dataset of administrative records, we investigate the influence of patient insurance status on the consumption of drugs, with a discerning focus on the disparate utilization of Western drugs and TCM. Our empirical results reveal a pattern in which insured patients exhibit increased expenditure on TCM and decreased outlay on Western drugs relative to their uninsured counterparts, suggesting that physicians are incentivized to prescribe profit-generating TCM rather than Western drugs with zero markup. A heterogeneity analysis confirms the consistency of these findings across varied health insurance schemes and a pronounced tendency among patients aged over 30. Our findings illuminate the dynamics of provider-induced demand in the pharmaceutical sector under China’s ZMP, contributing to the discourse on policy-induced perverse incentives in healthcare provisioning.

Evaluation of use and identification of predictive factors for nonuse of peripheral venous catheters in the emergency department.

The placement of peripheral venous catheters (PVC) is a frequent procedure in the emergency department (ED), which exposes patients to complications (hematoma, fluid leakage, phlebitis, edema, infection), increases hemolysis of blood samples, is time-consuming and costly. The main aim of this study is to analyze the rate of PVC nonuse in the ED and to identify predictive factors of their nonuse. This prospective single-center observational study was conducted in the ED of the Saint-Antoine Hospital in Paris, France between February and March 2022. Adult patients receiving a PVC were included. In addition to demographic and medical data, the reason for PVC prescription and the prescribing physician's expectation of PVC use were collected. A total of 304 patients were included, with a median age of 61.5years (IQR: 43-79years), of whom 152 (50%) were men. PVC were primarily prescribed for intravenous medication administration. Seventy-two (23.7%) PVC were not used. In multivariable analysis, the predictive factors of nonuse were the prescribing physician's expectation of nonuse [OR 6.35, CI 95% (2.64-15.29), for "no" and "not sure" vs. "yes" responses] and the reason for prescribing "just in case" [OR 3.54, CI 95% (1.37-9.17)]. PVC were not used in 23.7% of cases. Predictors of nonuse were the prescribing physician's expectation of nonuse and the reason for prescribing "just in case". A PVC should probably not be prescribed if the prescribing physician thinks it will not be used or prescribes it "just in case".

Invisible Victims and the Case for OTC SSRIs.

Major depressive disorder is one of the most common serious illnesses worldwide; the disease is also among those with the lowest rates of treatment. Barriers to access to care, both practical and psychological, contribute significantly to these low treatment rates. Among such barriers are regulations in many nations that require a physician's prescription for most pharmacological treatments including selective serotonin reuptake inhibitors (SSRIs). These rules are designed to protect patients. However, such regulations involve a tradeoff between the welfare of "visible" victims, who might suffer negative consequences from a lack of regulation, and the well-being of invisible "victims," who likely experience negative consequences that result from increased barriers to care. This article explores these tradeoffs and argues in favor of shifting SSRIs from prescription-only to over-the-counter status.

Development of a pharmacy-based HIV PrEP service delivery intervention for Washington, District of Columbia (DC): A study protocol.

Pharmacy-based PrEP service delivery models can help address many of the barriers that inhibit the uptake of PrEP. In an increasing number of states, legislation has been passed, or is under consideration, to allow pharmacists to initiate PrEP without a prescription from a physician or other prescriber. However, there is not yet legislation in Washington, DC to allow pharmacy-based PrEP despite its potential to curb new cases of HIV, which disproportionately affect the Black community in the area. The DC Ends HIV Plan has a goal of less than 130 new cases of HIV per year by 2030, which would require that over 13,000 high-risk residents use PrEP. However, in 2021 only 6,724 Washingtonians were taking PrEP. This study seeks to address the absence of critical formative research into the factors that would influence the implementation of pharmacy-based PrEP in Washington DC using the Implementation Mapping (IM) framework. A needs assessment will be conducted through in-depth interviews (IDIs) with pharmacists (n = 6), PrEP providers (n = 6), current PrEP users (n = 6), DC Department of Health officials (n = 2), DC Board of Pharmacy officials (n = 4) and pharmacy-based PrEP experts (n = 4) to provide input on the operational aspects of pharmacy-based PrEP model as a strategy to increase PrEP uptake. Information gathered through this needs assessment will be used to develop standard operating procedures for the introduction of pilot pharmacy-based PrEP into community-based retail pharmacies.

The personnel support of the long-turn care system in the Russian Federation

In Russia, over the past few years, long-term care system is developing as pilot project. Its main goal is to maintain habitual lifestyle of citizens of retirement age and the disabled who have functional impairments and who need help in household chores, sanitary hygienic procedures performance, medications intake, medical procedures execution and and physician prescriptions following in general. According to approved standard model of long-term care main sources of long-term care services are social security system, health care system, relatives and friends of service addressees. However, full-fledged and systemic implementation of program requires not only definition of these components, but also establishment of mechanism of interaction between them. For this, in most cases, elimination of normative inconsistencies impeding care and consideration of interests of elder citizens and the disabled is required. At the same time, it is necessary to foresee personnel staffing for long-term care, since this area is labor-intensive and is based on people interaction, model of person-to-person care. The problems with personnel staffing in medical and social sphere were present earlier, prior to development of long-term care system and without their elimination it is impossible to implement program in accordance with approved road-map. The training of medical specialists to working with older people, training of junior medical personnel to perform sanitary hygienic and medical procedures, provision with social and medical personnel rural areas are among tasks to be implemented. The article presents evaluation of compliance of components of long-term care system with program tasks, including medical personnel staffing and compliance of standards in force with interests of citizens.

Knowledge attitude and practice of antibiotic use among medical students in Bangladesh: A cross-sectional study.

Antibiotic misuse represent a significant global health challenge, with medical students positioned as key figures in promoting responsible antibiotic usage. This study investigates the knowledge, attitudes, and practices (KAP) regarding antibiotic use among medical students in Bangladesh, aiming to identify areas for targeted educational and policy interventions. This cross-sectional survey was conducted among 501 medical students across various years of study in Bangladesh, collecting data over a 3-month period. The survey assessed antibiotic knowledge, usage practices, and attitudes towards misuse, employing descriptive statistics and multiple logistic regression analyses to explore associations between students' demographic characteristics and their KAP towards antibiotics. Significance was assigned at p-value < 0.05. In our study involving 501 medical students from four medical colleges in Bangladesh, we achieved a 76% response rate. Among the participants, 78.24% correctly identified antibiotics' effectiveness against bacterial infections, but 45.71% were uncertain about their efficacy against viral infections. Notably, 21.20% reported self-prescribing antibiotics, predominantly sourced from physician prescriptions (54.89%). The most common reason for antibiotic use was fever (19.02%). Senior students were less likely to have good knowledge compared to junior students, and urban students demonstrated a higher likelihood of good knowledge and positive attitude towards antibiotic resistance. This study highlights the critical need for educational reforms and antimicrobial stewardship among medical students in Bangladesh to combat antibiotic misuse and mitigate antimicrobial resistance.

National and interprovincial prescribing patterns of JAK-inhibitors in Canada: a repeated cross-sectional analysis.

Janus Kinase (JAK) inhibitors have emerged as a novel category of medications to treat a variety of immune-mediated conditions. However, limited insight exists regarding the impact of safety concerns on their usage and prescribing practices. Therefore, the objective of this study was to describe the utilization of JAK-inhibitors in Canada, both nationally and within individual provinces.We used data from IQVIA's Compuscript database. We conducted a repeated cross-sectional study of all JAK-inhibitor units dispensed in retail pharmacies (tofacitinib, ruxolitinib, baricitinib, and upadacitinib) within the ten Canadian provinces from July 1, 2016, to June 30, 2022.Throughout Canada, outpatient pharmacies dispensed an estimated total of 26,126,409 JAK-inhibitor units between 2016 and 2022, averaging 9,431 units dispensed per 100,000 population. All provinces had increasing rates of JAK-inhibitor units dispensed over time, whereby between July 2021 to June 2022, New Brunswick exhibited the highest rates (27,696 units per 100,000), and Prince Edward Island demonstrated the lowest rates (10,065 units per 100,000).In this study, utilization of JAK-inhibitors increased in Canada over the study period, evident at both provincial and national levels. Variability in JAK-inhibitor utilization between provinces underscores the necessity for further investigations to ascertain appropriate usage practices. Key Points • From 2016 to 2022, an estimated total of 26,126,409 JAK-inhibitor units were dispensed in retail pharmacies across Canada, with an average rate of 9,431 units dispensed for every 100,000 people in the population. • Tofacitinib was the most dispensed JAK-inhibitor during the entire study period, making up 76% of all units dispensed. Ruxolitinib, upadacitinib, and baricitinib made up 16%, 7.9%, and 1.1% of the JAK-inhibitor units dispensed, respectively. • The variance in provincial adoption of JAK-inhibitors across Canada might be influenced by several factors, including drug coverage availability, disease prevalence, and physician prescribing patterns.

Evaluation of infectious diseases physicians’ attitudes to dyslipidemia management in PLWH

ABSTRACT Objectives Dyslipidemia is a well-established risk factor for atherosclerotic cardiovascular disease (ASCVD). ASCVD prevalence among people living with HIV (PLWH) is twice that of the general population. This study aimed to evaluate the infectious diseases (ID) physicians’ attitudes on dyslipidemia management in PLWH. Methods This observational, cross-sectional study was conducted as online survey among ID physicians between November 2023 and February 2024. An e-mail with the survey link, title and purpose of the study was sent to physicians through the local ID societies. The survey included questions about physicians’ demographic characteristics and their attitudes toward treating dyslipidemia in PLWH. Results A total of 242 physicians responded to the survey, of whom 59.9% (n = 145) were ID specialists and 40.1% (n = 97) were ID residents. Forty-one percent (n = 100) of physicians reported that they did not follow a guideline, and 26% of physicians reported that they did not use a cardiovascular risk calculator in their clinical practice. Specialists (69%) were more likely than residents (43.3%) to follow clinical guidelines for dyslipidemia management (p < 0.001). Seventy-two percent (n = 174) of physicians doubted the need to treat dyslipidemia, and 73% (n = 177) of physicians were affected by the patient skepticism. Workload and lack of time were identified by 68.6% of physicians as barriers to implementing dyslipidemia guideline recommendations. Conclusion A considerable number of Turkish ID physicians did not prefer using clinical guidelines for dyslipidemia and ASCVD risk calculators. Statin prescribing of physicians was influenced by workload, lack of time, patient skepticism, and lack of knowledge. Training ID physicians in primary prevention of ASCVD and management of dyslipidemia in PLWH is paramount.

Physician preferences for treatment of low-density lipoprotein cholesterol among patients with atherosclerotic cardiovascular disease (ASCVD)–A discrete choice experiment

ObjectiveApproximately 80 % of patients with atherosclerotic cardiovascular disease (ASCVD) do not achieve the guideline-based target for low-density lipoprotein (LDL-C) levels in current clinical practice, particularly the 95 % of ASCVD patients receiving oral statin monotherapy. The objective was to determine physician prescribing preferences for LDL-C lowering therapies beyond statins for patients with ASCVD. MethodsA discrete choice experiment (DCE) survey was administered to cardiologists and primary care physicians in the United States, presenting a series of treatment choices systematically varied across 8 treatment attributes: % LDL-C reduction, myalgias, other side effects, route and frequency of administration, time to prior authorization, patient monthly out-of-pocket cost (mOOP), and adherence. Data were analyzed using logistic regression to estimate preference weights for each attribute. ResultsA total of 200 cardiologists and 50 primary care physicians (PCPs) completed the survey. Both exhibited similar prescribing preferences, highly valuing efficacy in reducing LDL-C levels and minimization of patients OOP cost. Each additional 10 % reduction in LDL-C was associated with a 69 % relative increase in physician preference. By contrast, a 10 % relative decrease in preference was observed for each $10 additional monthly mOOP. Compared to PCPs, cardiologists tended to place more emphasis on LDL-C reduction, being more willing to accept higher mOOP or side effects. Although oral therapies were preferred, injectable therapies, like the PCSK9 siRNA-like drug, administered less frequently that allowed for greater LDL-C reduction were seen as having considerable utility, especially among patients with a history of medication nonadherence. ConclusionThese results document considerable preference similarities among cardiologist and PCP prescribers of LDL-C lowering therapies for ASCVD. Broad availability of several therapies with varying administration frequencies and product profiles are likely of great value to prescribing physicians aiming to achieve target LDL-C concentrations. Considering all aspects of treatment, most participants preferred a PCSK9 siRNA-like drug.

Why Do Physicians Prescribe Antibiotics? A Systematic Review of the Psycho-Socio-Organisational Factors Related to Potentially Inappropriate Prescribing of Antimicrobials in Europe.

Purpose: Effective antimicrobial use enhances care quality and combats antibiotic resistance. Yet, non-guideline factors influence potentially inappropriate prescribing. This study explores psycho-socio-organisational factors in antimicrobial prescribing as perceived by physicians across primary, secondary, and tertiary care. Methods: Adhering to PRISMA guidelines, a systematic review was conducted using PubMed and Scopus databases from 1 January 2000, to 8 March 2023, with an update search until 30 January 2024. Inclusion criteria focused on studies in Europe exploring psycho-socio-organisational factors for antibiotic prescribing from physicians' perspectives in hospital, inpatient, or primary care settings. Exclusion criteria targeted out-of-office prescriptions or low-quality studies. To evaluate the latter, several quality and risk-of-bias checklists were used. Data were extracted on study characteristics, study design, and methods and identified determinants of antibiotic prescribing. Data was analysed using a narrative synthesis method. Results: Among 8370 articles, 58 met inclusion criteria, yielding 35 articles from 23 countries. Three main themes emerged: personal, psychological, and organisational factors, encompassing seven determinants including work experience, knowledge, guideline adherence, uncertainty management, perceived pressure, time constraints, and diagnostic resource availability. Uncertainty management was key, with work experience and knowledge mitigating it. No additional factors emerged in the updated search. Conclusion: Enhanced uncertainty management decreases perceived patient and/or parental pressure to prescribe antibiotics, contributing to reducing potentially inappropriate prescribing (PIP). Therefore, it is imperative to educate physicians on effectively managing uncertainty. Interventions to improve antibiotic prescribing should be tailored to the specific needs and preferences of the different prescribing physicians.

Knowledge and Perceptions of Self-Medication Among Bachelor of Medicine and Bachelor of Surgery (MBBS) Students: A Cross-Sectional, Questionnaire-Based Study.

Self-medication (SM) is a common practice worldwide, and the irrational use of drugs is a cause of concern. Self-medication has various forms, including taking medications without a physician's prescription, using a previous prescription for a similar condition, or using drugs obtainable at home without getting a physician's advice. The youth are highly influenced by the media and the internet, which promote SM behavior. To determine the knowledge and perceptions of SM in Bachelor of Medicine and Bachelor of Surgery (MBBS) students in all professional years, including interns in Acharya Shri Chander College of Medical Sciences (ASCOMS) and Hospital, Jammu. The present study was conducted at ASCOMS Hospital, Jammu. A total of 200 students of MBBS were included in the study. A self-structured questionnaire was used to assess the knowledge and awareness level. The collected data were recorded in a Microsoft Excel sheet (Microsoft Corp., Redmond, WA) and analyzed with the help of IBM SPSS Statistics software for Windows, version 21.0 (IBM Corp., Armonk, NY). The present study reveals that 60% of the subjects were males and 65% of the students practiced SM, which indicates that SM is highly prevalent amongst MBBS students. It was observed that minor illness and quick relief were the major reasons for SM. Further, headache, cold/cough, and fever were the major indications for SM, whereas antipyretics and analgesics were the most commonly used drugs for SM. Conclusion: The present study concluded that there was a high prevalence of SM practice among medical students, especially among females. However, the knowledge and perceptions of SM were not insufficient.

Antibiotic Prescription Rates For Respiratory Tract Infections Treated In The Outpatient Sector Based On Routine Data From A German Health Insurance Company

Acute uncomplicated upper respiratory tract infections (RTIs) are common reasons for antibiotic prescriptions in the outpatient sector, although>90% are of viral origins and mostly self-limiting. Germany has a low antibiotic prescription rate compared to other European countries, but there are regional differences. Disease-specific quality indicators (QI) developed by the European Surveillance of Antimicrobial Consumption Network (ESAC-Net) address the prescription rates (target <20%) and choice of antibiotic (target>80%) in a general practitioner population. The aim of this analysis was to operationalise the ESAC-Net-QI using secondary data from a health insurance company at the level of diseases and healthcare facilities, as well as to analyse areas for improvement. The underlying database comprises the panel physician billing, hospital and prescription data in accordance with German law (§§ 295, 300 and 301 SGB V) of the Barmer health insurance company for the year 2022. Categorical features are presented as frequency and percentage. Maximum specificity was aimed, hence potentially risky disease courses were excluded. The overall RTI prescription rate of antibiotics was 25% in 2022 before applying inclusion and exclusion criteria (1,197,568/4,720,786). After applying the algorithm, the prescription rate for all RTI cases dropped to 6% (80,786/1,365,646). When specific RTI indications are considered, 35% (13,465/38,913) of acute bronchitis and acute sinusitis cases (4,971/14,051) received an antibiotic prescription each. At the facility level, 38% of practices (1,396/3,705) treating acute bronchitis and 41% of practices (539/1,300) treating acute sinusitis achieved the target of<20% antibiotic prescriptions. Only 29% of all RTI cases with antibiotic prescriptions (23,733/80,786) received a first-choice antibiotic. Our analysis indicates that the ESAC-Net-QI for RTIs can be calculated at case and facility levels using routine health insurance data. For specific RTIs, there were indications of improvement potential in the frequency and selection of prescribed antibiotics.

Revealing the synergetic influence of pharmaceutical marketing strategies on physician prescription patterns: a moderated mediation investigation

PurposeThis study aims to investigate the combined impact of pharmaceutical marketing strategies, specifically free drug samples and interactions with medical representatives, on physicians’ attitudes and prescribing behavior in Jammu and Kashmir, India.Design/methodology/approachTo achieve this objective, data were collected from a sample comprising 425 physicians. A six-point forced-choice Likert scale was used for data collection, and cluster sampling techniques were used in the study design.FindingsThe study reveals significant insights into pharmaceutical marketing’s influence on physician behavior. Free drug samples exert a positive influence on both physician attitudes and prescribing behavior. Physicians’ attitudes, in turn, significantly affect their prescribing decisions. Mediation analysis demonstrates that free drug samples indirectly influence prescribing behavior through shifts in physician attitudes. Effective medical representatives amplify this influence, as stronger associations between free drug samples and physician attitudes are observed when representatives are more effective.Originality/valueThis research contributes by unraveling the intricate dynamics between marketing strategies, physician attitudes and prescribing behavior in Jammu and Kashmir, India. It underscores the importance of ethical pharmaceutical marketing practices, highlighting the substantial role of free drug samples and the crucial function of effective medical representatives in shaping physician behavior. Ultimately, this study sheds light on how responsible pharmaceutical marketing and adept medical representatives can improve health-care outcomes in the region.

Blockchain technology and raft consensus for secure physician prescriptions and improved diagnoses in electronic healthcare systems

With electronic healthcare systems undergoing rapid change, optimizing the crucial process of recording physician prescriptions is a task with major implications for patient care. The power of blockchain technology and the precision of the Raft consensus algorithm are combined in this article to create a revolutionary solution for this problem. In addition to addressing these issues, the proposed framework, by focusing on the challenges associated with physician prescriptions, is a breakthrough in a new era of security and dependability for the healthcare sector. The Raft algorithm is a cornerstone that improves the diagnostic decision-making process, increases confidence in patients, and sets a new standard for robust healthcare systems. In the proposed consensus algorithm, a weighted sum of two influencing factors including the physician acceptability and inter-physicians’ reliability is used for selecting the participating physicians. An investigation is conducted to see how well the Raft algorithm performs in overcoming prescription-related roadblocks that support a compelling argument for improved patient care. Apart from its technological benefits, the proposed approach seeks to revolutionize the healthcare system by fostering trust between patients and providers. Raft’s ability to communicate presents the proposed solution as an effective way to deal with healthcare issues and ensure security.

Changes in outpatient antibiotic prescriptions by U.S. physicians and advanced practice providers, 2011 and 2022

Background: The number of advanced practice providers (APPs)—nurse practitioners (NPs) and physician assistants (PAs)—continues to expand across the United States. Several studies suggest differences in antibiotic prescribing rates and appropriateness by APPs compared to physicians. The objective of this analysis is to characterize population- and provider-specific outpatient antibiotic prescribing rates among physicians and APPs nationally, by state, and within urban versus rural counties. Methods: We estimated outpatient oral antibiotic prescription rates for 2011 and 2022 using county-level prescription dispensing data from IQVIA Xponent® (numerator) and population census estimates (denominator). Provider specialty denominators were provided by IQVIA, based on data from the American Medical Association. Counties were classified as urban or rural per the 2013 National Center for Health Statistics classification. National and state-level prescription volume, rates per 1000 population, and average number of prescriptions per provider were calculated for physicians, NPs, and PAs. We assessed the degree to which provider-specific rates explained the variance of the overall rate by state, using the coefficient of determination (r2) from Pearson’s correlation. Results: Between 2011 and 2022, overall U.S. antibiotic prescribing declined from 877 to 709 per 1000 population, a 19.2% relative reduction. The provider-specific proportion of the overall prescribing rate relatively decreased by 32% for physicians but increased by 157% for APPs (NPs 229%, PAs 86%; Figure 1). State-level antibiotic prescribing rates varied by provider type for both years, shifting towards proportionally greater APP prescribing in 2022 (Figure 2). For 2011 and 2022, physician prescribing rate strongly correlated with the overall state rate (r2 = 0.83 in 2011 versus 0.80 in 2022), whereas the correlation of the NP prescribing rate increased (r2 = 0.20 in 2011 versus 0.76 in 2022). A total of 60,327 (7.2%) physicians practiced in rural settings in contrast to 42,876 (12%) NPs and 14,495 (9.4%) PAs in 2022. Providers in rural counties prescribed more antibiotics per provider on average compared to urban counties; rural physicians prescribed 57% more antibiotics per provider (207 vs 132 antibiotics per provider), rural NPs prescribed 115% more (284 vs 132), and rural PAs prescribed 53% more (289 vs 189). Conclusions: The relative contribution of APPs to outpatient antibiotic prescriptions more than doubled over the past decade, accounting for 1 in 3 prescriptions in 2022. This contribution was especially prominent among NPs in rural counties. Further evaluation of antibiotic prescribing appropriateness among APPs and integration of APPs into antibiotic stewardship efforts in various settings.

Real-world outcomes for a digital prescription mobile application for adults with irritable bowel syndrome.

Mahana™ IBS is a Food and Drug Administration-cleared prescription mobile application designed to deliver 3 months of gut-directed cognitive behavioral therapy (CBT) to adults ≥22 years old with irritable bowel syndrome (IBS). We assessed whether gut-directed CBT delivered digitally improved outcomes in IBS management. We studied users who had a dispensed physician prescription for Mahana™ IBS between August 2021 and August 2023. The primary outcome was change in IBS symptom severity (IBS-SSS) score. For the 843 patients, 324 (38%) completed half of the program up to session 5, and 162 (19%) of participants completed the full program up to session 10. Median age was 41 years, median IBS-SSS was 270 (moderate severity), IBS-mixed subtype was most common (23%) followed by IBS-C (20%) and IBS-D (19%). The change in IBS-SSS was -81.0 (p = < 0.001) after session 5 and - 104.4 (p = < 0.001) after session 10. In multivariate analyses, a higher baseline IBS-SSS (OR 1.59; 95% CI 1.26-2.01) and high baseline Perceived Stress Scale (PSS) score predicted non-response (OR 0.95; 95% CI 0.91-0.98) while older age (OR 1.10 per decade; 95% CI 1.01-1.20), prescription source from a healthcare provider (as opposed to third party telehealth encounter, OR 1.48; 95% CI 1.07-2.05), and payment for the app (OR 1.93; 95% CI 1.41-2.63) predicted adherence. Use of a digital mobile application for gut-directed CBT improved symptoms of IBS. Digital health applications have the potential to democratize CBT and allow integrated care to scale for patients with IBS.

Racial and socioeconomic disparities in fertility treatment provision for patients with polycystic ovary syndrome

ObjectiveTo assess whether provision of fertility treatment for patients with polycystic ovary syndrome (PCOS) varies by patient and physician level demographics. DesignRetrospective cohort study SubjectsPatients at a university health system seeking care for PCOS and infertility from 2007-2021. ExposurePatient age, BMI, race, ethnicity, estimated household income, primary insurance payor, provider sex, and provider medical specialty. Main outcome measuresPrescriptions for fertility treatment, including clomiphene citrate, letrozole, and injectable gonadotropins. Differences in patient and physician demographics between patients who did and did not receive a prescription were identified with univariable analysis. Multilevel mixed-effects logistic regression was performed to determine associations between patient and physician demographics and prescription receipt. Results3,435 patients with PCOS and infertility were identified with a mean age of 31.1 +/- 5.7 years. Of the 68.8% of patients who received a prescription, 47.8% of prescriptions were clomiphene citrate, 38.6% letrozole, and 13.7% injectable gonadotropins. There were lower odds of prescription receipt for Black patients compared to White patients (aOR 0.75, 95% CI 0.61-0.93), those with estimated household income below the federal poverty level (FPL) compared to above the national median (aOR 0.71, 95% CI 0.46-0.97), and those with public compared to commercial insurance (aOR 0.53, 95% CI 0.40-0.71). These disparities persisted in a subanalysis of patients prescribed oral medications only with lower odds of prescription receipt for Black compared to White patients (aOR 0.74, 95% CI 0.57-0.95), those with estimated household income below the FPL compared to above the national median (aOR 0.93, 95% CI 0.87-0.98), and those with public compared to commercial insurance (aOR 0.57, 95% CI 0.42-0.76). Black patients waited on average 153.3 days longer than White patients from initial visit to prescription receipt. Patients had lower odds of receiving any prescription from family medicine physicians (aOR 0.36, 95% CI 0.24-0.52) and general internal medicine physicians (aOR 0.55, 95% CI 0.42-0.73) compared to reproductive endocrinologists. ConclusionRacial and socioeconomic disparities exist in the provision of infertility treatments for patients with PCOS. Fewer primary care physicians engaged in first-line fertility treatment, indicating an opportunity for physician education to improve access to fertility care.