Variations in antibiotic use for respiratory tract infections
Bibliographic record
Abstract
ABSTRACT ObjectivesAntibiotic resistance is a significant public health issue, driven in large part by selection pressure induced by antibiotic use. Despite knowledge that a reduction in inappropriate antibiotic use is important, significant and sustained behaviour change has remained difficult to achieve. Previous studies have suggested that prescribing decisions vary with patient comorbidities and age, as well as the physician’s age, claim volume, specialty, and continuity of care with the particular patient. Regional level variation has also been reported. The goal of this study is to explore variations in antibiotic prescribing for respiratory tract infections (RTIs) at the levels of patients, physicians, and regions. ApproachWe used data on fee-for-service physician visits from the universal Medical Services Plan (MSP) for all residents of British Columbia, Canada from 2002 to 2012. We identified a cohort of patient visits for RTI (ICD-9 codes 460-466, 480, or 487). We derived measures of healthcare use and comorbidities at the patient level, and measures of physician claim volume and frequency of respiratory tract infection management, at the level of the physician. We used data on antibiotics filled by individuals, the number of all medications filled by individuals each year, and counts of prescriptions written by physicians (and filled) by month, from the provincial drug insurance database. We linked antibiotic prescriptions to physician visits by patient and prescriber as antibiotics dispensed within 5 days after the RTI visit. We calculated measures of regional population distributions. We used data on meteorological temperature readings assigned to each region, for each day, and calculated 28-day moving averages. We linked data on patient demographics, physician demographics, and hospitalizations to our dataset. Our analysis will use hierarchical generalized linear mixed models (GLMMs) with logit link to account for the clustering effects of patients among physicians and regions, to model the odds of an antibiotic prescription being dispensed. Measures of variation will be discussed. ResultsBetween April 1, 2005 and March 31, 2012, there were over 10.5 million visits by nearly 3 million individuals, served by over 8000 physicians in 88 regions. Antibiotics were prescribed in 37% of all visits. ConclusionThese are preliminary results, with full analytic results available in the coming months. These results will have implications for better understanding the extent of variations in antibiotic prescribing, and some of the drivers of these variations, as well as the potential to inform ongoing efforts to improve the appropriateness of antibiotic use.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".