Influence of provider and urgent care density across different socioeconomic strata on outpatient antibiotic prescribing in the USA
Influence of provider and urgent care density across different socioeconomic strata on outpatient antibiotic prescribing in the USA
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DOI：
10.1093/jac/dku563
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发表时间：
2015-05-01
影响因子：
5.2
通讯作者：
Laxminarayan, Ramanan
中科院分区：
文献类型：
--
作者：
Klein, Eili Y.;Makowsky, Michael;Laxminarayan, Ramanan
目的：尽管抗生素使用与耐药性之间存在密切联系，而且美国各地的抗生素消费率差异很大，但消费率差异的驱动因素尚未完全了解。本研究的目的是研究供应商密度如何影响美国社会经济群体的抗生素处方率。我们将2000年和2010年美国零售药店填写的所有门诊抗生素处方的数据从IMS Health汇总到3436个地理上不同的医院服务区域，并将其与影响抗生素处方的社会经济和结构因素相结合。美国人口普查。然后，我们使用固定效应模型来估计贫困和人均医生办公室数量（即医生密度）之间的相互作用，以及抗生素处方率的紧急护理和零售诊所的存在。结果：我们发现处方的地理差异很大，部分是由人均医生办公室数量驱动的。人均医生办公室数量增加一个标准差，人均处方量增加25.9%。然而，处方率的决定因素取决于社会经济条件。在较贫困地区，诊所取代了传统的医生办公室，减少了医生密度的影响。在较富裕的地区，诊所增加了医生密度对处方率的影响。结论：在贫困率较高的地区，获得供应商驱动处方率。然而，在较富裕的地区，获得服务的问题较小，提供者和诊所的密度较高会增加处方率，这可能是由于竞争。
Objectives: Despite a strong link between antibiotic use and resistance, and highly variable antibiotic consumption rates across the USA, drivers of differences in consumption rates are not fully understood. The objective of this study was to examine how provider density affects antibiotic prescribing rates across socioeconomic groups in the USA.Methods: We aggregated data on all outpatient antibiotic prescriptions filled in retail pharmacies in the USA in 2000 and 2010 from IMS Health into 3436 geographically distinct hospital service areas and combined this with socioeconomic and structural factors that affect antibiotic prescribing from the US Census. We then used fixed-effect models to estimate the interaction between poverty and the number of physician offices per capita (i.e. physician density) and the presence of urgent care and retail clinics on antibiotic prescribing rates.Results: We found large geographical variation in prescribing, driven in part by the number of physician offices per capita. For an increase of one standard deviation in the number of physician offices per capita there was a 25.9% increase in prescriptions per capita. However, the determinants of the prescription ratewere dependent on socio-economic conditions. In poorer areas, clinics substitute for traditional physician offices, reducing the impact of physician density. In wealthier areas, clinics increase the effect of physician density on the prescribing rate.Conclusions: In areas with higher poverty rates, access to providers drives the prescribing rate. However, in wealthier areas, where access is less of a problem, a higher density of providers and clinics increases the prescribing rate, potentially due to competition.