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Open Access

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 and Kevin L. Schwartz
March 08, 2021 9 (1) E175-E180; DOI: https://doi.org/10.9778/cmajo.20200122
Bradley J. Langford
Public Health Ontario (Langford, Chen, Daneman, Brown, Johnstone, Wu, Leung, Garber, Schwartz), Toronto, Ont.; Hotel Dieu Shaver Health and Rehabilitation Centre (Langford), St. Catharines, Ont.; ICES Central (Chen, Gomes, Schwartz); Sunnybrook Health Sciences Centre (Daneman); Dalla Lana School of Public Health (Brown, Schwartz), University of Toronto; Keenan Research Centre of the Li Ka Shing Knowledge Institute (Gomes), St. Michael’s Hospital; Sinai Health System (Johnstone); Michael Garron Hospital (Leung), Toronto East Health Network, Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont.
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Cynthia Chen
Public Health Ontario (Langford, Chen, Daneman, Brown, Johnstone, Wu, Leung, Garber, Schwartz), Toronto, Ont.; Hotel Dieu Shaver Health and Rehabilitation Centre (Langford), St. Catharines, Ont.; ICES Central (Chen, Gomes, Schwartz); Sunnybrook Health Sciences Centre (Daneman); Dalla Lana School of Public Health (Brown, Schwartz), University of Toronto; Keenan Research Centre of the Li Ka Shing Knowledge Institute (Gomes), St. Michael’s Hospital; Sinai Health System (Johnstone); Michael Garron Hospital (Leung), Toronto East Health Network, Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont.
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Nick Daneman
Public Health Ontario (Langford, Chen, Daneman, Brown, Johnstone, Wu, Leung, Garber, Schwartz), Toronto, Ont.; Hotel Dieu Shaver Health and Rehabilitation Centre (Langford), St. Catharines, Ont.; ICES Central (Chen, Gomes, Schwartz); Sunnybrook Health Sciences Centre (Daneman); Dalla Lana School of Public Health (Brown, Schwartz), University of Toronto; Keenan Research Centre of the Li Ka Shing Knowledge Institute (Gomes), St. Michael’s Hospital; Sinai Health System (Johnstone); Michael Garron Hospital (Leung), Toronto East Health Network, Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont.
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Kevin A. Brown
Public Health Ontario (Langford, Chen, Daneman, Brown, Johnstone, Wu, Leung, Garber, Schwartz), Toronto, Ont.; Hotel Dieu Shaver Health and Rehabilitation Centre (Langford), St. Catharines, Ont.; ICES Central (Chen, Gomes, Schwartz); Sunnybrook Health Sciences Centre (Daneman); Dalla Lana School of Public Health (Brown, Schwartz), University of Toronto; Keenan Research Centre of the Li Ka Shing Knowledge Institute (Gomes), St. Michael’s Hospital; Sinai Health System (Johnstone); Michael Garron Hospital (Leung), Toronto East Health Network, Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont.
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Tara Gomes
Public Health Ontario (Langford, Chen, Daneman, Brown, Johnstone, Wu, Leung, Garber, Schwartz), Toronto, Ont.; Hotel Dieu Shaver Health and Rehabilitation Centre (Langford), St. Catharines, Ont.; ICES Central (Chen, Gomes, Schwartz); Sunnybrook Health Sciences Centre (Daneman); Dalla Lana School of Public Health (Brown, Schwartz), University of Toronto; Keenan Research Centre of the Li Ka Shing Knowledge Institute (Gomes), St. Michael’s Hospital; Sinai Health System (Johnstone); Michael Garron Hospital (Leung), Toronto East Health Network, Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont.
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Jennie Johnstone
Public Health Ontario (Langford, Chen, Daneman, Brown, Johnstone, Wu, Leung, Garber, Schwartz), Toronto, Ont.; Hotel Dieu Shaver Health and Rehabilitation Centre (Langford), St. Catharines, Ont.; ICES Central (Chen, Gomes, Schwartz); Sunnybrook Health Sciences Centre (Daneman); Dalla Lana School of Public Health (Brown, Schwartz), University of Toronto; Keenan Research Centre of the Li Ka Shing Knowledge Institute (Gomes), St. Michael’s Hospital; Sinai Health System (Johnstone); Michael Garron Hospital (Leung), Toronto East Health Network, Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont.
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Julie Wu
Public Health Ontario (Langford, Chen, Daneman, Brown, Johnstone, Wu, Leung, Garber, Schwartz), Toronto, Ont.; Hotel Dieu Shaver Health and Rehabilitation Centre (Langford), St. Catharines, Ont.; ICES Central (Chen, Gomes, Schwartz); Sunnybrook Health Sciences Centre (Daneman); Dalla Lana School of Public Health (Brown, Schwartz), University of Toronto; Keenan Research Centre of the Li Ka Shing Knowledge Institute (Gomes), St. Michael’s Hospital; Sinai Health System (Johnstone); Michael Garron Hospital (Leung), Toronto East Health Network, Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont.
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Valerie Leung
Public Health Ontario (Langford, Chen, Daneman, Brown, Johnstone, Wu, Leung, Garber, Schwartz), Toronto, Ont.; Hotel Dieu Shaver Health and Rehabilitation Centre (Langford), St. Catharines, Ont.; ICES Central (Chen, Gomes, Schwartz); Sunnybrook Health Sciences Centre (Daneman); Dalla Lana School of Public Health (Brown, Schwartz), University of Toronto; Keenan Research Centre of the Li Ka Shing Knowledge Institute (Gomes), St. Michael’s Hospital; Sinai Health System (Johnstone); Michael Garron Hospital (Leung), Toronto East Health Network, Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont.
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Gary Garber
Public Health Ontario (Langford, Chen, Daneman, Brown, Johnstone, Wu, Leung, Garber, Schwartz), Toronto, Ont.; Hotel Dieu Shaver Health and Rehabilitation Centre (Langford), St. Catharines, Ont.; ICES Central (Chen, Gomes, Schwartz); Sunnybrook Health Sciences Centre (Daneman); Dalla Lana School of Public Health (Brown, Schwartz), University of Toronto; Keenan Research Centre of the Li Ka Shing Knowledge Institute (Gomes), St. Michael’s Hospital; Sinai Health System (Johnstone); Michael Garron Hospital (Leung), Toronto East Health Network, Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont.
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Kevin L. Schwartz
Public Health Ontario (Langford, Chen, Daneman, Brown, Johnstone, Wu, Leung, Garber, Schwartz), Toronto, Ont.; Hotel Dieu Shaver Health and Rehabilitation Centre (Langford), St. Catharines, Ont.; ICES Central (Chen, Gomes, Schwartz); Sunnybrook Health Sciences Centre (Daneman); Dalla Lana School of Public Health (Brown, Schwartz), University of Toronto; Keenan Research Centre of the Li Ka Shing Knowledge Institute (Gomes), St. Michael’s Hospital; Sinai Health System (Johnstone); Michael Garron Hospital (Leung), Toronto East Health Network, Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont.
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Article Figures & Tables

Tables

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    Table 1:

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

    CharacteristicAntibiotic 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
     < 10528 (7.0)194 (7.8)494 (6.6)228 (9.1)
     10–203746 (50.0)1068 (42.8)3814 (50.9)1000 (40.0)
     > 203222 (43.0)1236 (49.5)3188 (42.5)1270 (50.8)
    Age, median (IQR), yr53 (44–61)53 (44–61)51 (42–59)58 (49–66)
    Sex
     Female3533 (47.1)933 (37.3)3784 (50.5)682 (27.3)
     Male3963 (52.9)1565 (62.7)3712 (49.5)1816 (72.7)
    Years since medical graduation
     < 111644 (21.9)482 (19.3)1830 (24.4)296 (11.8)
     11–242173 (29.0)767 (30.7)2410 (32.2)530 (21.2)
     > 243679 (49.1)1249 (50.0)3256 (43.4)1672 (66.9)
    Country of medical school
     Canada/United States4661 (62.2)1527 (61.1)4525 (60.4)1663 (66.6)
     Other1703 (22.7)620 (24.8)1657 (22.1)666 (26.7)
     Unknown1132 (15.1)351 (14.0)1314 (17.5)169 (6.8)
    Rurality
     Urban6791 (90.6)2296 (91.9)6891 (91.9)2196 (87.9)
     Rural705 (9.4)202 (8.1)605 (8.1)302 (12.1)
    Emergency department visits, mean ± SD, %8.35 ± 22.620.9 ± 35.114.03 ± 29.33.85 ± 14.8
    Long-term care visits, mean ± SD, %2.44 ± 9.91.59 ± 8.71.03 ± 4.85.81 ± 15.2
    Roster size, median (IQR)1101 (752–1540)1080 (616–1561)1026 (683–1448)1303 (893–1729)
    Practices
    Age group, mean ± SD, yr
     < 1815.6 ± 7.117.7 ± 7.017.1 ± 7.1131 ± 6.4
     18–6460.5 ± 10.061.3 ± 9.662.0 ± 9.056.7 ± 11.3
     ≥ 6524.0 ± 12.421.0 ± 11.420.9 ± 10.230.2 ± 14.7
    Female sex, mean ± SD, %57.1 ± 9.156.1 ± 6.957.7 ± 8.554.1 ± 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 infarction0.5 ± 0.50.5 ± 0.40.5 ± 0.40.7 ± 0.6
     Congestive heart failure0.9 ± 0.90.8 ± 0.70.8 ± 0.81.1 ± 1.1
     Chronic obstructive pulmonary disease1.2 ± 0.81.1 ± 0.71.1 ± 0.71.4 ± 0.9
     Diabetes1.6 ± 0.81.4 ± 0.61.4 ± 0.71.7 ± 0.8
     Hypertension2.3 ± 0.92.1 ± 0.82.2 ± 0.82.4 ± 1.0
     Asthma0.9 ± 0.51.1 ± 0.51.0 ± 0.50.8 ± 0.5
     Mental health condition20.6 ± 7.820.8 ± 6.220.6 ± 6.920.8 ± 8.9
    Health care use in previous 2 yr, mean ± SD, %
     Hospital admission14.6 ± 6.315.0 ± 6.014.4 ± 5.815.6 ± 7.3
     Emergency department visit41.9 ± 12.246.1 ± 13.742.7 ± 12.843.8 ± 12.5
    • Note: IQR = interquartile range, SD = standard deviation.

    • ↵* Except where noted otherwise.

    • View popup
    Table 2:

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

    OpioidAntibiotic; κ (95% CI)*
    InitiationSelectionDuration
    Initiation0.00 (−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.

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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
Jan 2021, 9 (1) E175-E180; DOI: 10.9778/cmajo.20200122

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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
Jan 2021, 9 (1) E175-E180; DOI: 10.9778/cmajo.20200122
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