Identifying General Practitioners' Antibiotic Prescribing Profiles Based on National Health Reimbursement Data

Pauline Arias; Matta Matta; Alessio Strazzulla; Christine Le Mener; Sébastien Gallien; Sylvain Diamantis

doi:10.1093/ofid/ofae172

Identifying General Practitioners' Antibiotic Prescribing Profiles Based on National Health Reimbursement Data

Open Forum Infect Dis. 2024 Mar 21;11(4):ofae172. doi: 10.1093/ofid/ofae172. eCollection 2024 Apr.

Authors

Pauline Arias^{1

2}, Matta Matta¹, Alessio Strazzulla¹, Christine Le Mener³, Sébastien Gallien^{4

5}, Sylvain Diamantis^{1

5}

Affiliations

¹ Infectious Diseases Department, Groupe Hospitalier Sud Ile-de-France, Melun, France.
² Infectious Diseases Department, Centre hospitalier intercommunal de Villeneuve Saint Georges, Villeneuve Saint Georges, France.
³ Caisse primaire d'assurance maladie Seine-et-Marne, Ile-de-France, Melun, France.
⁴ Infectious Diseases Department, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Université Paris Est Créteil, Créteil, France.
⁵ EA 7380 Dynamic, Université Paris Est Créteil, Créteil, France.

Abstract

Background: Antibiotic selection pressure in human medicine is a significant driver of antibiotic resistance in humans. The primary aspect of antibiotic consumption is associated with general practitioner (GP) prescriptions. We aimed to identify prescriber profiles for targeted antimicrobial stewardship programs using novel indicators.

Methods: A cross-sectional study was conducted in 2018 investigating GPs' antibiotic prescriptions in a French department, utilizing the reimbursement database of the national health service. Three antibiotic prescribing indicators were used. Specific targets were established for each indicator to identify the antibiotic prescribers most likely contributing to the emergence of resistance.

Results: Over 2018, we had 2,908,977 visits to 784 GPs, leading to 431,549 antibiotic prescriptions. Variations between GPs were shown by the 3 indicators. The median antibiotic prescription rate per visit was 13.6% (interquartile range [IQR], 9.8%-17.7%). Median ratios of the prescriptions of low-impact antibiotics to the prescriptions of high-impact antibiotics and of amoxicillin prescriptions to amoxicillin-clavulanic acid prescriptions were 2.5 (IQR, 1.7-3.7) and 2.94 (IQR, 1.7-5), respectively. We found 163 (21%) high prescribers of antibiotics with 3 distinct patterns: The first group overuses broad-spectrum antibiotics but without an overprescription rate per visit, the second group displays an overprescription rate but no excessive use of broad-spectrum antibiotics, and the third group shows both an overprescription rate and excessive use of broad-spectrum antibiotics.

Conclusions: Prescription-based indicators enable the identification of distinct profiles of antibiotic prescribers. This identification may allow for targeted implementation of stewardship programs focused on the specific prescribing patterns of each profile.

Keywords: antibiotic consumption; antibiotic stewardship; general practitioners; primary healthcare; quality indicators.