2277. Variability in Changes in Physician Outpatient Antibiotic Prescribing from 2019 to 2021 during the COVID-19 Pandemic in Ontario, Canada
Bibliographic record
Abstract
Abstract Background Outpatient antibiotic prescribing decreased during the COVID-19 pandemic. Understanding how antibiotic prescribing habits changed differentially based on physician and practice characteristics presents an opportunity to inform antibiotic stewardship. Our objective was to evaluate inter-physician variability and predictors of changes in antibiotic prescribing before (2019) and during (2020/2021) the COVID-19 pandemic. Methods We conducted a retrospective cohort analysis of physicians in Ontario, Canada prescribing oral antibiotics in the outpatient setting between 1 January 2019 and 31 December 2021 using the IQVIA Xponent dataset. The primary outcome was the change in the number of antibiotic prescriptions between the pre-pandemic and pandemic period. Secondary outcomes were changes in the selection of broad-spectrum agents and long-duration ( >7 days) antibiotic use. We used multivariable linear regression models to evaluate physician- and practice-level predictors of change. Results There were 17,288 physicians included in the study with substantial inter-physician variability in changes in antibiotic prescribing (median change of -43.5 antibiotics per physician, IQR -136.5 to -5.0). In the multivariable model, later career stage (adjusted mean difference [aMD] -45.3, 95% confidence interval [CI] -52.9 to -37.8, p< .001), family medicine (aMD -46.0, 95% CI -62.5 to -29.4, p< .001), male patient sex (aMD -52.4, 95% CI -71.1 to -33.7, p< .001), low patient comorbidity (aMD -42.5, 95% CI -50.3 to -34.8, p< .001), and high prescribing to new patients (aMD -216.5, 95% CI -223.5 to -209.5, p< .001) were associated with decreases in antibiotic initiation. Family medicine and high prescribing to new patients were associated with significant decreases in selection of broad-spectrum agents and prolonged antibiotic use. Conclusion Antibiotic prescribing changed throughout the COVID-19 pandemic with overall decreases in antibiotic initiation, broad-spectrum agents, and prolonged antibiotic courses with inter-physician variability. These findings present opportunities for targeted community antibiotic stewardship interventions. Disclosures All Authors: No reported disclosures
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".