RT Journal Article
SR Electronic
T1 Concordance between high antibiotic prescribing and high opioid prescribing among primary care physicians: a cross-sectional study
JF CMAJ Open
JO CMAJ
FD Canadian Medical Association
SP E175
OP E180
DO 10.9778/cmajo.20200122
VO 9
IS 1
A1 Bradley J. Langford
A1 Cynthia Chen
A1 Nick Daneman
A1 Kevin A. Brown
A1 Tara Gomes
A1 Jennie Johnstone
A1 Julie Wu
A1 Valerie Leung
A1 Gary Garber
A1 Kevin L. Schwartz
YR 2021
UL http://www.cmajopen.ca/content/9/1/E175.abstract
AB Background: Antimicrobial resistance and opioid misuse both present major public health challenges, and identifying high prescribers of both of these agents can help provide a common target for intervention. We sought to determine the association between being a high prescriber of antibiotics and being a high prescriber of opioids in the primary care setting.Methods: We performed a cross-sectional study of the antibiotic- and opioid-prescribing habits of primary care physicians in Ontario, Canada between Mar. 1, 2017, and Feb. 28, 2018, using administrative databases. We defined high prescribers as the top quartile of antibiotic or opioid prescribers using 3 antibiotic-prescribing metrics (prescriptions per patient visit, proportion of prescriptions that were broad spectrum and proportion of prescriptions > 8 d) and 3 opioid-prescribing metrics (prescriptions per patients seen, proportion of prescriptions > 90 mg of morphine equivalents and proportion of prescriptions > 28 d). We tabulated agreement between prescribing metrics using the κ statistic.Results: We included 9994 physicians. We observed minimal overlap between high antibiotic initiation and high opioid initiation (618 physicians [6.2%]) (κ = 0.00, 95% confidence interval −0.02 to 0.02). There was slight agreement between the antibiotic-prescribing indices and between the opioid-prescribing indices (within-class, range of κ 0.05 to 0.18). There was slight disagreement to slight agreement across antibiotic- and opioid-prescribing metrics (between-class, range of κ −0.09 to 0.16).Interpretation: Among primary care physicians, there was a lack of association between high antibiotic prescribing and high opioid prescribing. Our findings suggest that separate tailored approaches to antibiotic and opioid stewardship strategies are needed.