Inappropriate outpatient antibiotic use in children insured by Kentucky Medicaid.

Journal Article (Journal Article)

OBJECTIVE: To describe risk factors associated with inappropriate antibiotic prescribing to children. DESIGN: Cross-sectional, retrospective analysis of antibiotic prescribing to children, using Kentucky Medicaid medical and pharmacy claims data, 2017. PARTICIPANTS: Population-based sample of pediatric Medicaid patients and providers. METHODS: Antibiotic prescriptions were identified from pharmacy claims and used to describe patient and provider characteristics. Associated medical claims were identified and linked to assign diagnoses. An existing classification scheme was applied to determine appropriateness of antibiotic prescriptions. RESULTS: Overall, 10,787 providers wrote 779,813 antibiotic prescriptions for 328,515 children insured by Kentucky Medicaid in 2017. Moreover, 154,546 (19.8%) of these antibiotic prescriptions were appropriate, 358,026 (45.9%) were potentially appropriate, 163,654 (21.0%) were inappropriate, and 103,587 (13.3%) were not associated with a diagnosis. Half of all providers wrote 12 prescriptions or less to Medicaid children. The following child characteristics were associated with inappropriate antibiotic prescribing: residence in a rural area (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.07-1.1), having a visit with an inappropriate prescriber (OR, 4.15; 95% CI, 4.1-4.2), age 0-2 years (OR, 1.39; 95% CI, 1.37-1.41), and presence of a chronic condition (OR, 1.31; 95% CI, 1.28-1.33). CONCLUSIONS: Inappropriate antibiotic prescribing to Kentucky Medicaid children is common. Provider and patient characteristics associated with inappropriate prescribing differ from those associated with higher volume. Claims data are useful to describe inappropriate use and could be a valuable metric for provider feedback reports. Policies are needed to support analysis and dissemination of antibiotic prescribing reports and should include all provider types and geographic areas.

Full Text

Duke Authors

Cited Authors

  • Wattles, BA; Jawad, KS; Feygin, Y; Kong, M; Vidwan, NK; Stevenson, MD; Smith, MJ

Published Date

  • May 2022

Published In

Volume / Issue

  • 43 / 5

Start / End Page

  • 582 - 588

PubMed ID

  • 33975663

Electronic International Standard Serial Number (EISSN)

  • 1559-6834

Digital Object Identifier (DOI)

  • 10.1017/ice.2021.177


  • eng

Conference Location

  • United States