Concordance between high antibiotic prescribing and high opioid prescribing among primary care physicians: a cross-sectional study

Bradley J. Langford; Cynthia Chen; Nick Daneman; Kevin A. Brown; Tara Gomes; Jennie Johnstone; Julie Wu; Valerie Leung; Gary Garber; Kevin L. Schwartz

doi:10.9778/cmajo.20200122

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Table 1:

Characteristics of high and lower antibiotic and opioid initiators and their practices

Characteristic	Antibiotic initiators; no. (%) of physicians^*		Opioid initiators; no. (%) of physicians^*

	Lowest 75% n = 7496	Highest 25% n = 2498	Lowest 75% n = 7496	Highest 25% n = 2498
Physicians

Median no. of daily patient visits

< 10	528 (7.0)	194 (7.8)	494 (6.6)	228 (9.1)

10–20	3746 (50.0)	1068 (42.8)	3814 (50.9)	1000 (40.0)

> 20	3222 (43.0)	1236 (49.5)	3188 (42.5)	1270 (50.8)

Age, median (IQR), yr	53 (44–61)	53 (44–61)	51 (42–59)	58 (49–66)

Sex

Female	3533 (47.1)	933 (37.3)	3784 (50.5)	682 (27.3)

Male	3963 (52.9)	1565 (62.7)	3712 (49.5)	1816 (72.7)

Years since medical graduation

< 11	1644 (21.9)	482 (19.3)	1830 (24.4)	296 (11.8)

11–24	2173 (29.0)	767 (30.7)	2410 (32.2)	530 (21.2)

> 24	3679 (49.1)	1249 (50.0)	3256 (43.4)	1672 (66.9)

Country of medical school

Canada/United States	4661 (62.2)	1527 (61.1)	4525 (60.4)	1663 (66.6)

Other	1703 (22.7)	620 (24.8)	1657 (22.1)	666 (26.7)

Unknown	1132 (15.1)	351 (14.0)	1314 (17.5)	169 (6.8)

Rurality

Urban	6791 (90.6)	2296 (91.9)	6891 (91.9)	2196 (87.9)

Rural	705 (9.4)	202 (8.1)	605 (8.1)	302 (12.1)

Emergency department visits, mean ± SD, %	8.35 ± 22.6	20.9 ± 35.1	14.03 ± 29.3	3.85 ± 14.8

Long-term care visits, mean ± SD, %	2.44 ± 9.9	1.59 ± 8.7	1.03 ± 4.8	5.81 ± 15.2

Roster size, median (IQR)	1101 (752–1540)	1080 (616–1561)	1026 (683–1448)	1303 (893–1729)

Practices

Age group, mean ± SD, yr

< 18	15.6 ± 7.1	17.7 ± 7.0	17.1 ± 7.1	131 ± 6.4

18–64	60.5 ± 10.0	61.3 ± 9.6	62.0 ± 9.0	56.7 ± 11.3

≥ 65	24.0 ± 12.4	21.0 ± 11.4	20.9 ± 10.2	30.2 ± 14.7

Female sex, mean ± SD, %	57.1 ± 9.1	56.1 ± 6.9	57.7 ± 8.5	54.1 ± 8.2

Neighbourhood income quintile of patient population

Low (1–3)	6141 (81.9)	2050 (82.1)	5942 (79.3)	2249 (90.0)

High (4–5)	1355 (18.1)	448 (17.9)	1554 (20.7)	249 (10.0)

Comorbidities in previous 2 yr, mean ± SD, %

Acute myocardial infarction	0.5 ± 0.5	0.5 ± 0.4	0.5 ± 0.4	0.7 ± 0.6

Congestive heart failure	0.9 ± 0.9	0.8 ± 0.7	0.8 ± 0.8	1.1 ± 1.1

Chronic obstructive pulmonary disease	1.2 ± 0.8	1.1 ± 0.7	1.1 ± 0.7	1.4 ± 0.9

Diabetes	1.6 ± 0.8	1.4 ± 0.6	1.4 ± 0.7	1.7 ± 0.8

Hypertension	2.3 ± 0.9	2.1 ± 0.8	2.2 ± 0.8	2.4 ± 1.0

Asthma	0.9 ± 0.5	1.1 ± 0.5	1.0 ± 0.5	0.8 ± 0.5

Mental health condition	20.6 ± 7.8	20.8 ± 6.2	20.6 ± 6.9	20.8 ± 8.9

Health care use in previous 2 yr, mean ± SD, %

Hospital admission	14.6 ± 6.3	15.0 ± 6.0	14.4 ± 5.8	15.6 ± 7.3

Emergency department visit	41.9 ± 12.2	46.1 ± 13.7	42.7 ± 12.8	43.8 ± 12.5

Note: IQR = interquartile range, SD = standard deviation.
↵* Except where noted otherwise.

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Table 2:

Concordance between high antibiotic-prescribing metrics and high opioid-prescribing metrics (cross opioid–antibiotic class)

Opioid	Antibiotic; κ (95% CI)^*
Opioid	Initiation	Selection	Duration
Initiation	0.00 (−0.02 to 0.02)	0.16 (0.14 to 0.19)	0.05 (0.03 to 0.07)
Selection	−0.09 (−0.11 to −0.07)	−0.02 (−0.04 to 0.00)	0.03 (0.01 to 0.05)
Duration	−0.09 (−0.11 to −0.07)	0.03 (0.01 to 0.05)	0.07 (0.05 to 0.09)

Note: CI = confidence interval.
↵* Values between −0.01 and −0.20 indicate slight disagreement, values including 0 indicate no agreement, and values between 0.01 and 0.20 indicate slight agreement.