Study Finds Inappropriate Antibiotic Prescribing In 45% Of Medicaid Patients

A new study by Northwestern Medicine found shockingly high rates of improper antibiotic prescribing for Medicaid patients. Before this study, antibiotic prescribing for patients on Medicaid had not been studied. The study was recently published in Health Affairs, regarded by The Washington Post as “the bible of health policy.”

Medicaid is the largest source of health coverage in the United States. It’s the public health insurance program for those with lower incomes. Health Affairs researchers used Medicaid data to find out whether patients visited a clinic within seven days prior to antibiotics being prescribed. They also checked whether there was an infection when there was an actual visit. Unfortunately, they found out that 28% of the antibiotics were prescribed with no evidence of a doctor visit and 17% at an office visit unrelated to infection.

Antibiotics help to effectively treat bacterial infections and to also prevent infection in surgery, organ transplants, and in patients undergoing cancer treatment. But they may expose patients to harmful drug events such as diarrhea, nausea, rashes, yeast infections, and life-threatening allergic reactions. Random use of antibiotics may increase the prevalence of antibiotic-resistant bacteria making them ineffective.

Clinical policies in the United States are in place to help reduce the rate of antibiotic prescribing, which is twice more than in many other countries. However, these policies are limited. Ambulatory antibiotic policies, for example, don’t capture antibiotics prescribed outside of a doctor visit or without clear indications for use. In order to improve antibiotic use, there needs to be a clear understanding of the context in which they are being prescribed.

The study was based on claims data, and there are no medical records to determine the interactions that took place with clinicians. The study concluded these prescriptions are linked to telephone interaction, and some communication may have taken place over email, web portals, or perhaps uncaptured visits, which are blind spots for intervention.

The new study has raised questions about the effectiveness of attempts to reduce inappropriate antibiotic prescribing. But researchers also note that the classification scheme may help future efforts to evaluate comprehensibly antibiotic use in the United States. The data should be used to encourage change in how, when, and where these common antibiotics are prescribed.

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