Evaluating Appropriateness of Antibiotic Use for Children with Otitis Media in Rhode Island
- Presenter:
Chair: Melayne McInnes; Discussant: TBA Mon June 5, 2006 17:15-18:45 Room 121
Background: The rapid growth in antibiotic use in the 1980s spurred concerns about the spread of antibiotic resistance. Otitis media (OM) is one of the leading indicators for outpatient antibiotic use despite the fact that it is clinically self-resolving. Additionally, most children have at least one OM episode by age 7. These factors led to evidence-based guidelines for the treatment of OM which recommend that antibiotic therapy (i.e. high-dose amoxicillin) should be the default treatment only for children under age 6 months, with use in more limited circumstances in older children. Existing studies have been restricted to either national office-based surveys or state Medicaid populations; little is known of antibiotic practices within a market despite the local nature of practice patterns and disease spread. Objectives: To assess whether antibiotic use among children with otitis media insured by Blue Cross & Blue Shield of Rhode Island (BCBSRI), the dominant insurer in the state of Rhode Island, is consistent with established evidence-based guidelines, and whether this use varies by visit or demographic characteristics.
Methodology: The study uses a cohort of children age 13 or under as of January 1, 2004 who had a diagnosis of otitis media at any time during 2004, and were continuously enrolled with BCBSRI with both medical and drug coverage. The visit-based analysis uses logistic regressions on the probability of receipt of any antibiotic, and the probability that the child receive amoxicillin given that an antibiotic was received; covariates included visit location (hospital inpatient, hospital outpatient, physician office or urgent care), insurance coverage type (PPO, HMO and Medicaid managed care), age (<6 months, 6 months - 2 years, over 2 years), and an indicator for whether the visit occurred on the weekend.
Data: Data come from BCBSRI administrative encounter and pharmacy claims in 2004. Antibiotic prescriptions filled within 2 days of an otitis-related encounter were matched to encounter data. The sample included 12,436 children, who were associated with 26,090 otitis-related encounters and 9,318 matched antibiotic prescriptions.
Results: Preliminary results show that the use of antibiotics by age is consistent with evidence-based practices; children under age 6 months are more likely to receive an antibiotic, with most children receiving the recommended antibiotic of amoxicillin. Interestingly, no differences were found by insurance coverage type. However, the likelihood of receiving an antibiotic are much higher for care provided at urgent care centers (versus physician offices or the hospital emergency room) and for visits occurring on the weekend (versus weekday).
Conclusions: Antibiotics may be used less judiciously for children with otitis media when care is sought outside of their usual source of care. Sites such as urgent care centers may have practice patterns that deviate from recommended pediatric practices because of less familiarity with both the patients themselves, and pediatric patients in general. At the same time, urgent care centers may play a role in reducing costly emergency room visits for acute visits.
