ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2017
Influences on the start, selection and duration of treatment with antibiotics in long-term care facilities.
Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 5 of them syntheses that pooled it.
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Who cites it
30 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Resident-, prescriber-, and facility-level factors associated with antibiotic use in long-term care facilities: a systematic review of quantitative studies.Antimicrobial resistance and infection control · 2024Pooled it
- Factors contributing to the variation in antibiotic prescribing among primary health care physicians: a systematic review.BMC primary care · 2024Pooled it
- Burden of Clostridioides difficile infection (CDI) - a systematic review of the epidemiology of primary and recurrent CDI.BMC infectious diseases · 2021Pooled it
- Pooled it
- Effectiveness of interventions targeting antibiotic use in long-term aged care facilities: a systematic review and meta-analysis.BMJ open · 2020Pooled it
- Population-Wide Peer Comparison Audit and Feedback to Reduce Antibiotic Initiation and Duration in Long-Term Care Facilities with Embedded Randomized Controlled Trial.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Trial
- Antimicrobials in serious illness and end-of-life care: lifting the veil of silence.The Lancet. Infectious diseases · 2025Review
- Antibiotic prescribing for care-home residents: a population-based, cross-classified multilevel analysis in Scotland, UK.Age and ageing · 2025Article
- Antimicrobial prescribing in French nursing homes and interventions for antimicrobial stewardship: a qualitative study.Antimicrobial resistance and infection control · 2024Article
- Antibiotic consumption in French nursing homes between 2018 and 2022: A multicenter survey.Infection control and hospital epidemiology · 2024Article
- Antibiotic Prescribing Patterns for Urinary Tract Infections and Pneumonia by Prescriber Type and Specialty in Nursing Home Care, 2016-2018.Journal of the American Medical Directors Association · 2024Article
- Physician antimicrobial prescribing and patient outcomes on general medical wards: a multicentre retrospective cohort study.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2023Article
- Impact of a Multifaceted Intervention on Antibiotic Prescribing for Cystitis and Asymptomatic Bacteriuria in 23 Community Hospital Emergency Departments.Hospital pharmacy · 2023Article
- Best practice guidance for antibiotic audit and feedback interventions in primary care: a modified Delphi study from the Joint Programming Initiative on Antimicrobial resistance: Primary Care Antibiotic Audit and Feedback Network (JPIAMR-PAAN).Antimicrobial resistance and infection control · 2023Article
- Examining antibiotic prescribing and urine culture testing for urinary tract infections (UTIs) in a primary care spinal cord injury (SCI) cohort.Spinal cord · 2023Article
- Antibiotic prescribing and antimicrobial stewardship in long-term care facilities: Past interventions and implementation challenges.Canada communicable disease report = Releve des maladies transmissibles au Canada · 2022Article
- Latent Class Analysis of Prescribing Behavior of Primary Care Physicians in the Veterans Health Administration.Journal of general internal medicine · 2022Article
- Behavioral Nudges to Improve Audit and Feedback Report Opening Among Antibiotic Prescribers: A Randomized Controlled Trial.Open forum infectious diseases · 2022Article
- Comparison of Medication Prescribing Before and After the COVID-19 Pandemic Among Nursing Home Residents in Ontario, Canada.JAMA network open · 2021Observational
- Trends in Anticoagulant Use at Nursing Home Admission and Variation by Frailty and Chronic Kidney Disease Among Older Adults with Atrial Fibrillation.Drugs & aging · 2021Article
Corrections and comments
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundUnderstanding the extent to which current antibiotic prescribing behaviour is influenced by clinicians' historical patterns of practice will help target interventions to optimize antibiotic use in long-term care. Our objective was to evaluate whether clinicians' historical prescribing behaviours influence the start, prolongation and class selection for treatment with antibiotics in residents of long-term care facilities.
methodsWe conducted a retrospective cohort study of all physicians who prescribed to residents in long-term care facilities in Ontario between Jan. 1 and Dec. 31, 2014. We examined variability in antibiotic prescribing among physicians for 3 measures: start of treatment with antibiotics, use of prolonged durations exceeding 7 days and selection of fluoroquinolones. Funnel plots with control limits were used to determine the extent of variation and characterize physicians as extreme low, low, average, high and extreme high prescribers for each tendency. Multivariable logistic regression was used to assess whether a clinician's prescribing tendency in the previous year predicted current prescribing patterns, after accounting for residents' demographics, comorbidity, functional status and indwelling devices.
resultsAmong 1695 long-term care physicians, who prescribed for 93 132 residents, there was wide variability in the start of antibiotic treatment (median 45% of patients, interquartile range [IQR] 32%-55%), use of prolonged treatment durations (median 30% of antibiotic prescriptions, IQR 19%-46%) and selection of fluoroquinolones (median 27% of antibiotic prescriptions, IQR 18%-37%). Prescribing tendencies for antibiotics by physicians in 2014 correlated strongly with tendencies in the previous year. After controlling for individual resident characteristics, prior prescribing tendency was a significant predictor of current practice.
interpretationPhysicians prescribing antibiotics exhibited individual, measurable and historical tendencies toward start of antibiotic treatment, use of prolonged treatment duration and class selection. Prescriber audit and feedback may be a promising tool to optimize antibiotic use in long-term care facilities.
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