OBJECTIVES: In an effort to improve antimicrobial stewardship practices, this study aims to identify patient- and provider-level characteristics associated with inappropriate antibiotic prescribing following uncomplicated acute adult bronchitis (AAB) visits and the association of inappropriate prescribing on healthcare utilization.

METHODS: A retrospective cohort study on adult patients seen in a Baylor Scott & White Health (BSWH) ambulatory clinic was conducted using BSWH electronic medical record data. Outpatient visits coded for AAB from January 1, 2017 to August 13, 2018 were included in the study. The primary outcome of interest was visit-level inappropriate antibiotic prescribing, defined as any AAB visit that resulted in an oral antibiotic prescription. Secondary outcome of interest was healthcare utilization, defined as any inpatient, outpatient, or emergency department visit up to 6 weeks following the index visit date. Logistic regression was used to examine the factors predictive of inappropriate prescribing.

RESULTS: A total of 35,383 visits were included in the study, which involved 31,638 unique patients seen across 428 outpatient clinics and 1,019 providers. 28,788 (81%) of visits resulted in an antibiotic prescription. Patient factors associated with a lower likelihood of antibiotic receipt included female gender (odds ratio [OR] 0.885, P=0.0003) and Medicaid insurance (OR 0.436, P=0.0045). Non-significant factors included patient age (OR 0.999, P=0.6829) and Elixhauser comorbidity index (OR 1.022, P=0.1017). Specialty physicians were 45.6% less likely to prescribe antibiotics than internal or family medicine physicians (OR 0.544, P<0.0001). A non-significant association between antibiotic order at visit and subsequent visit in the following 6 weeks was found (adjusted OR 1.021, P=0.5564).

CONCLUSIONS: Patients were more likely to receive antibiotics with male gender, Commercial insurance, and when provider type is a primary care physician. Further research targeting specific sub-populations is needed to reduce inappropriate antibiotic prescribing.