Factors associated with the appropriateness of antibiotics prescribed in French general practice: a cross-sectional study using reimbursement databases

• Published in: Clinical microbiology and infection Vol. 28; no. 4; pp. 609.e1 - 609.e6
• Main Authors: Simon, Maïa, Thilly, Nathalie, Pereira, Ouarda, Pulcini, Céline
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.04.2022; Elsevier for the European Society of Clinical Microbiology and Infectious Diseases
• Subjects: Aged; Anti-Bacterial Agents - therapeutic use; Antibiotic prescriptions; Antimicrobial Stewardship; Appropriateness; Characteristics; Clusters; Cross-Sectional Studies; General Practice; General Practitioners; Human health and pathology; Humans; Inappropriate Prescribing; Infectious diseases; Life Sciences; Male; Practice Patterns, Physicians; Quality of care; Santé publique et épidémiologie; Characteristics; General practitioners; Antibiotic prescriptions; Clusters; Antimicrobial stewardship; Appropriateness; Quality of care
• ISSN: 1198-743X; 1469-0691
• DOI: 10.1016/j.cmi.2021.08.026

Identifying characteristics associated with the appropriateness of antibiotic prescriptions is useful to guide antibiotic stewardship interventions. Proxy indicators estimating the appropriateness of antibiotic prescriptions at the general practitioner (GP) level have recently been validated. Our objectives were to identify (a) clusters of GPs according to their appropriateness score based on these proxy indicator results, and (b) GPs', patients' and practices' characteristics associated with inappropriate prescriptions. We conducted a cross-sectional observational study analysing antibiotics prescribed by GPs in one large French region in 2019, using the Health Insurance databases. We identified clusters of GPs according to their appropriateness score calculated from ten proxy indicators' results. We then analysed the association between the clusters with more inappropriate practices compared with the one with less inappropriate practices, and GPs', patients', and practices' characteristics. We performed bivariate and multivariable analyses using logistic polytomous regressions. We included 4819 GPs who were grouped into three clusters. GPs who belong to the clusters with more inappropriate practices were more likely to practice in certain geographical area, to be male, not to have a particular medical practice, to be practicing for longer, to have more patients and consultations, to have a higher proportion of elderly patients, and to prescribe more drugs, more antibiotics and a higher proportion of broad-spectrum antibiotics. We identified clusters of practice as well as factors associated with the appropriateness of antibiotic prescriptions, using routinely collected data. This might help to guide antibiotic stewardship interventions.