Small group of higher-volume antibiotic prescribers identified

Over 40% of the antibiotic prescriptions filled by Medicare Part D beneficiaries in 2019 were prescribed by just 10% of health care providers, based on data from the Centers for Medicare & Medicaid Services.

“Higher-volume prescribers prescribed antibiotics to a larger share of their patient panel and their prescribing rate was 60% higher than that of lower-volume prescribers, indicating that their prescribing practices might be independent of the number of beneficiaries under their care,” Katryna A. Gouin, MPH, and associates wrote in the Morbidity and Mortality Weekly Report.

In 2019, 41% of all Part D antibiotics – that’s 24.4 million prescriptions – were prescribed by 69,835 higher-volume prescribers. The other 59% of all antibiotics were prescribed by the 627,000 lower-volume health care providers included in the analysis (those who prescribed fewer than 11 antibiotics were excluded), Ms. Gouin of Chenega in Anchorage, Alaska, and associates noted.

The analysis involved the Medicare Part D Prescribers by Provider data set and defined the highest-volume prescribers “as those in the highest 10th percentile of prescriber-level antibiotic volume (number of antibiotic prescriptions filled) across all Medicare providers nationwide,” the investigators explained.

The antibiotic-prescribing rate for the higher-volume prescribers was 680 prescriptions per 1,000 beneficiaries, which was 60% higher than the 426 prescriptions per 1,000 among the lower 90% of prescribers. Another way to look at it: The top 10% of health care providers “wrote a median of 284 antibiotic prescriptions, compared with a median of 41 among lower-volume prescribers,” the investigators said.

Physicians in internal medicine and family practice, the two largest medical specialties, were the most likely to be 10-percenters, accounting for 24.6% and 27.5%, respectively, of the higher-volume group. They were followed by nurse practitioners (14.1%) and physician assistants (7.4%), who were classified as specialists for the purposes of the study, Ms. Gouin and associates said.

The only other group of physicians among the top six specialties were urologists, who represented 6.8% of high-volume prescribers but only 1% of all prescribers, they noted.

The highest antibiotic prescription rate in the six largest groups of providers occurred among dentists, whose highest-prescribing practitioners wrote 1,271 prescriptions per 1,000 beneficiaries. Even the lower-prescribing 90% of dentists prescribed more antibiotics (1,068 per 1,000) than did the higher-prescribing family physicians (611 per 1,000) and internists (590 per 1,000), the researchers said.

The prescribing rates for all the other specialties that were not included separately also were higher than the family physicians’ and internists’. These rates were 850 per 1,000 beneficiaries for the higher-prescribers and 360 per 1,000 for the lower-prescribers, the researchers wrote.

The considerable differences in prescribing practices between specialties and even among those of the same specialty present “opportunities for improved prescribing through antibiotic stewardship activities focusing on these higher-volume prescribers, independent of specialty,” Ms. Gouin and associates wrote.

Over 40% of the antibiotic prescriptions filled by Medicare Part D beneficiaries in 2019 were prescribed by just 10% of health care providers, based on data from the Centers for Medicare & Medicaid Services.

“Higher-volume prescribers prescribed antibiotics to a larger share of their patient panel and their prescribing rate was 60% higher than that of lower-volume prescribers, indicating that their prescribing practices might be independent of the number of beneficiaries under their care,” Katryna A. Gouin, MPH, and associates wrote in the Morbidity and Mortality Weekly Report.

In 2019, 41% of all Part D antibiotics – that’s 24.4 million prescriptions – were prescribed by 69,835 higher-volume prescribers. The other 59% of all antibiotics were prescribed by the 627,000 lower-volume health care providers included in the analysis (those who prescribed fewer than 11 antibiotics were excluded), Ms. Gouin of Chenega in Anchorage, Alaska, and associates noted.

The analysis involved the Medicare Part D Prescribers by Provider data set and defined the highest-volume prescribers “as those in the highest 10th percentile of prescriber-level antibiotic volume (number of antibiotic prescriptions filled) across all Medicare providers nationwide,” the investigators explained.

The antibiotic-prescribing rate for the higher-volume prescribers was 680 prescriptions per 1,000 beneficiaries, which was 60% higher than the 426 prescriptions per 1,000 among the lower 90% of prescribers. Another way to look at it: The top 10% of health care providers “wrote a median of 284 antibiotic prescriptions, compared with a median of 41 among lower-volume prescribers,” the investigators said.

Physicians in internal medicine and family practice, the two largest medical specialties, were the most likely to be 10-percenters, accounting for 24.6% and 27.5%, respectively, of the higher-volume group. They were followed by nurse practitioners (14.1%) and physician assistants (7.4%), who were classified as specialists for the purposes of the study, Ms. Gouin and associates said.

The only other group of physicians among the top six specialties were urologists, who represented 6.8% of high-volume prescribers but only 1% of all prescribers, they noted.

The highest antibiotic prescription rate in the six largest groups of providers occurred among dentists, whose highest-prescribing practitioners wrote 1,271 prescriptions per 1,000 beneficiaries. Even the lower-prescribing 90% of dentists prescribed more antibiotics (1,068 per 1,000) than did the higher-prescribing family physicians (611 per 1,000) and internists (590 per 1,000), the researchers said.

The prescribing rates for all the other specialties that were not included separately also were higher than the family physicians’ and internists’. These rates were 850 per 1,000 beneficiaries for the higher-prescribers and 360 per 1,000 for the lower-prescribers, the researchers wrote.

The considerable differences in prescribing practices between specialties and even among those of the same specialty present “opportunities for improved prescribing through antibiotic stewardship activities focusing on these higher-volume prescribers, independent of specialty,” Ms. Gouin and associates wrote.

Over 40% of the antibiotic prescriptions filled by Medicare Part D beneficiaries in 2019 were prescribed by just 10% of health care providers, based on data from the Centers for Medicare & Medicaid Services.

“Higher-volume prescribers prescribed antibiotics to a larger share of their patient panel and their prescribing rate was 60% higher than that of lower-volume prescribers, indicating that their prescribing practices might be independent of the number of beneficiaries under their care,” Katryna A. Gouin, MPH, and associates wrote in the Morbidity and Mortality Weekly Report.

In 2019, 41% of all Part D antibiotics – that’s 24.4 million prescriptions – were prescribed by 69,835 higher-volume prescribers. The other 59% of all antibiotics were prescribed by the 627,000 lower-volume health care providers included in the analysis (those who prescribed fewer than 11 antibiotics were excluded), Ms. Gouin of Chenega in Anchorage, Alaska, and associates noted.

The analysis involved the Medicare Part D Prescribers by Provider data set and defined the highest-volume prescribers “as those in the highest 10th percentile of prescriber-level antibiotic volume (number of antibiotic prescriptions filled) across all Medicare providers nationwide,” the investigators explained.

The antibiotic-prescribing rate for the higher-volume prescribers was 680 prescriptions per 1,000 beneficiaries, which was 60% higher than the 426 prescriptions per 1,000 among the lower 90% of prescribers. Another way to look at it: The top 10% of health care providers “wrote a median of 284 antibiotic prescriptions, compared with a median of 41 among lower-volume prescribers,” the investigators said.

Physicians in internal medicine and family practice, the two largest medical specialties, were the most likely to be 10-percenters, accounting for 24.6% and 27.5%, respectively, of the higher-volume group. They were followed by nurse practitioners (14.1%) and physician assistants (7.4%), who were classified as specialists for the purposes of the study, Ms. Gouin and associates said.

The only other group of physicians among the top six specialties were urologists, who represented 6.8% of high-volume prescribers but only 1% of all prescribers, they noted.

The highest antibiotic prescription rate in the six largest groups of providers occurred among dentists, whose highest-prescribing practitioners wrote 1,271 prescriptions per 1,000 beneficiaries. Even the lower-prescribing 90% of dentists prescribed more antibiotics (1,068 per 1,000) than did the higher-prescribing family physicians (611 per 1,000) and internists (590 per 1,000), the researchers said.

The prescribing rates for all the other specialties that were not included separately also were higher than the family physicians’ and internists’. These rates were 850 per 1,000 beneficiaries for the higher-prescribers and 360 per 1,000 for the lower-prescribers, the researchers wrote.

The considerable differences in prescribing practices between specialties and even among those of the same specialty present “opportunities for improved prescribing through antibiotic stewardship activities focusing on these higher-volume prescribers, independent of specialty,” Ms. Gouin and associates wrote.