Racial Differences in Antibiotic Prescribing by Primary Care Pediatricians

To determine whether racial differences exist in antibiotic prescribing among children treated by the same clinician. Retrospective cohort study of 1,296,517 encounters by 208,015 children to 222 clinicians in 25 practices in 2009. Clinical, antibiotic prescribing, and demographic data were obtained...

Full description

Saved in:
Bibliographic Details
Published in:Pediatrics (Evanston) 2013-04, Vol.131 (4), p.677-684
Main Authors: GERBER, Jeffrey S, PRASAD, Priya A, RUSSELL LOCALIO, A, FIKS, Alexander G, GRUNDMEIER, Robert W, BELL, Louis M, WASSERMAN, Richard C, RUBIN, David M, KEREN, Ron, ZAOUTIS, Theoklis E
Format: Article
Language:English
Subjects:
Acute Disease
Adolescent
Agency ABCs
Ambulatory care
Ambulatory medical care
Anti-Bacterial Agents - therapeutic use
Antibiotics
Biological and medical sciences
Black or African American
Child
Child, Preschool
Children
Cohort Studies
Electronic Health Records
Epidemiology
Female
General aspects
Health aspects
Health participants
Healthcare Disparities - ethnology
Healthcare Disparities - statistics & numerical data
Humans
Infant
Infant, Newborn
Logistic Models
Male
Medical diagnosis
Medical personnel
Medical sciences
Multivariate Analysis
Otitis Media - diagnosis
Otitis Media - drug therapy
Otitis Media - ethnology
Pediatricians
Pediatrics
Practice
Practice Patterns, Physicians' - statistics & numerical data
Prescriptions
Primary care
Primary Health Care - statistics & numerical data
Public health. Hygiene
Public health. Hygiene-occupational medicine
Race discrimination
Racial differences
Respiratory Tract Infections - diagnosis
Respiratory Tract Infections - drug therapy
Respiratory Tract Infections - ethnology
Retrospective Studies
Social aspects
White People
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:To determine whether racial differences exist in antibiotic prescribing among children treated by the same clinician. Retrospective cohort study of 1,296,517 encounters by 208,015 children to 222 clinicians in 25 practices in 2009. Clinical, antibiotic prescribing, and demographic data were obtained from a shared electronic health record. We estimated within-clinician associations between patient race (black versus nonblack) and (1) antibiotic prescribing or (2) acute respiratory tract infection diagnosis after adjusting for potential patient-level confounders. Black children were less likely to receive an antibiotic prescription from the same clinician per acute visit (23.5% vs 29.0%, odds ratio [OR] 0.75; 95% confidence interval [CI]: 0.72-0.77) or per population (0.43 vs 0.67 prescriptions/child/year, incidence rate ratio 0.64; 95% CI 0.63-0.66), despite adjustment for age, gender, comorbid conditions, insurance, and stratification by practice. Black children were also less likely to receive diagnoses that justified antibiotic treatment, including acute otitis media (8.7% vs 10.7%, OR 0.79; 95% CI 0.75-0.82), acute sinusitis (3.6% vs 4.4%, OR 0.79; 95% CI 0.73-0.86), and group A streptococcal pharyngitis (2.3% vs 3.7%, OR 0.60; 95% CI 0.55-0.66). When an antibiotic was prescribed, black children were less likely to receive broad-spectrum antibiotics at any visit (34.0% vs 36.9%, OR 0.88; 95% CI 0.82-0.93) and for acute otitis media (31.7% vs 37.8%, OR 0.75; 95% CI 0.68-0.83). When treated by the same clinician, black children received fewer antibiotic prescriptions, fewer acute respiratory tract infection diagnoses, and a lower proportion of broad-spectrum antibiotic prescriptions than nonblack children. Reasons for these differences warrant further study.
ISSN:0031-4005
1098-4275
DOI:10.1542/peds.2012-2500