Antibiotics are among the most common medications prescribed in long-term care facilities, and often those prescriptions can be inappropriate and in fact dangerous to residents and to others in this setting. Prescribing antibiotics unnecessarily or for too long exposes people, especially more vulnerable seniors, to potentially avoidable harms like allergies, infections, and antibiotic resistance.
Understanding how and why antibiotics are being prescribed is the first step to improving care for residents of long-term care facilities. To do this, Professor Colleen Maxwell, part of a team of physicians and researchers led by Dr. Nick Daneman from Sunnybrook Research Institute and Division of Infectious Diseases, examined data on physician prescribing in long-term care facilities across Ontario.
Studying data from January to December of 2014, the team explored the impact that previous prescribing behaviour has on current behaviour after controlling for resident characteristics. The study included nearly 1700 physicians prescribing for 93,132 residents in Ontario long-term care facilities. The researchers examined variability in prescribing behaviour including antibiotic starts, use of prolonged durations exceeding a week, and use of a specific antibiotic class called fluoroquinolones.
Antibiotics are exceptionally effective medications if used properly. However, members of this team had previously discovered that the use of prolonged antibiotic treatment is in fact more dependent on who is prescribing the drug than on the characteristics of the resident receiving the drug. This new study revealed similar findings.
What we saw was that prescribing tendencies for physicians in 2014 corresponded strongly with their tendencies in the previous year
As summarized in their paper, the team found that physicians working in long-term care demonstrated individual and measurable tendencies towards starting antibiotics, towards prescribing them for over a week, and towards their use of specific drug classes. Previous prescribing behaviour was a significant predictor of current practice.
Exploring the connection between historical and current practices of prescribing antibiotics is one approach to explore behavioural influences on medication use,” explains Maxwell. “From there, we can determine how to more effectively target education and interventions in prescribing practice so that we can optimize the use of antibiotics in long-term care settings.
For the full study, see the Canadian Medical Association Journal website