Differences in US antibiotic prescription use by facility and patient characteristics: evidence from the National Ambulatory Medical Care Survey

Background. Antibiotic resistance is increasing, largely due to the overuse of antibiotics. Patient demographic characteristics can influence rates of antibiotic prescription, but less research has assessed the role of facility-level characteristics. Objective. The objective of this study was to examine the prevalence of antibiotic prescriptions for viral-like illness, as well as patient and provider factors that influence antibiotic prescription practices. Methods. We conducted an observational cohort study using data from the 2012 National Ambulatory Medical Care Survey. We compared the prevalence of antibiotic prescription for all aetiologies and for viral-like illnesses between community health centres, non-community health centre clinics and emergency departments. Then, we used logistic regression models to compare the odds of antibiotic prescription use by facility and patient characteristics. Results. Data came from 630 community health centre visits, 857 non-community health centre outpatient clinic visits and 627 emergency department visits. Compared to patients visiting non-community health centre clinics, patients visiting community health centres and emergency departments for any aetiology were more likely to receive antibiotic prescriptions. Patients with viral-like illnesses were less likely to receive antibiotics at community health centres and exhibited similar odds of receiving antibiotics at emergency departments. Certain patient demographics (age, race/ethnicity and payment source) were associated with variation in overall antibiotic prescription, but these factors were mostly unassociated with antibiotic prescription for viral-like illnesses. Conclusions. The care setting that patients visit may influence their odds of receiving antibiotics. Initiatives addressing overuse of antibiotics should be mindful of facility- and patient-based characteristics when designing interventions.