scholarly journals 1351. Pediatric Antibioitic Use in the North Carolina Medicaid Population

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S686-S686
Author(s):  
Rebecca R Young ◽  
Paul Lantos ◽  
Paul Lantos ◽  
Michael J Smith
Keyword(s):  
North Carolina ◽  
Metropolitan Area ◽  
Metropolitan Areas ◽  
Antibiotic Use ◽  
The United States ◽  
The State ◽  
Gis Mapping ◽  
Antibiotic Prescribing ◽  
Research Support ◽  
Race Ethnicity

Abstract Background Antimicrobial resistance is increasing in the United States, with antibiotic use as the main driver. The majority of antibiotic use occurs in the outpatient setting. 6 of the 7 highest prescribing states are located in the Appalachian region of the country. Overall, the state of North Carolina (NC) has prescribing rates that are at the national average, but the geographic, patient and provider-level characteristics associated with antibiotic prescribing within the state are unknown. Methods We used NC Medicaid claims from 2013-2018 to identify oral antibiotics prescribed to children, defined as individuals < 21 years. Antibiotics were identified using National Drug Codes. Overall rates of antibiotic prescribing were reported as the number of prescriptions per 1000 children overall and stratified by age, sex, race/ethnicity and residence in a metropolitan area. Provider characteristics and setting type were identified using existing variables in the Medicaid dataset. A geographic information system was used to graphically depict rates of antibiotic use by county. Results Rates of prescribing decreased from 724/1000 children in 2013 to 578/1000 children in 2018. Across all study years there were differences in prescribing rates by sex, race/ethnicity, age and residence in a metropolitan area. (Table) Prescriptions were more common in children who were younger (0-2), white non-Hispanic, female and living in non-metropolitan areas. Prescribing rates were geographically heterogeneous, with the highest rates in the western mountain region and declining across a west to east gradient. (Figure) Most (62%) antibiotic prescriptions were written in the primary care setting. Pediatricians prescribed 48% of all antibiotic courses. Antibiotic Prescriptions Per 1000 Children, by Demographic Group (2013-2018) Antibiotic Prescriptions per 1000 Children, by County (2013-2018) Conclusion Although NC is not a high-prescribing state in general, we found notable difference in prescribing based on key demographic characteristics. These results are consistent with prior reports from other Appalachian states including Kentucky, West Virginia and Tennessee. Rates of prescription were highest in non-metropolitan areas overall but GIS mapping revealed a marked west-east gradient. These data suggest that specific Appalachian characteristics, rather than rurality alone, may be associated with excessive antibiotic prescribing. Disclosures Michael J. Smith, MD, MSC.E, Kentucky Medicaid (Grant/Research Support)Merck (Grant/Research Support)

scholarly journals 1359. Utilization of West Virginia Pediatric Medicaid Claims Data to Guide Outpatient Antimicrobial Stewardship Interventions

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S691-S691
Author(s):  
Jacob T Kilgore ◽  
Mariana M Lanata Piazzon ◽  
Jonathan M Willis ◽  
Joseph Evans ◽  
Michael J Smith
Keyword(s):  
Information System ◽  
Geographic Information System ◽  
West Virginia ◽  
Pediatric Patients ◽  
Antibiotic Use ◽  
Gis Mapping ◽  
Oral Antibiotic ◽  
Research Support ◽  
Prescription Rates ◽  
Race Ethnicity

Abstract Background Antimicrobial resistance is a significant public health risk with overuse and misuse of antibiotics as primary drivers. West Virginia (WV) leads the nation in per capita prescribing in the outpatient setting, where the majority of antibiotic use occurs. Methods We analyzed outpatient pharmacy and medical claims for WV Medicaid recipients age < 20 years from 1/1/2018 – 12/31/2019. Dental claims were excluded. Oral antibiotics were identified using National Drug Codes (NDCs). Key demographic variables extracted from the claims include patient age (as of December 31st of that calendar year [CY]), sex, race, ethnicity, Medicaid region, place of medical service, provider, and cost. Rates of prescribing were calculated as the number of prescriptions per 1,000 children and stratified by age, race/ethnicity, sex, and WV Medicaid region. We used geographic information system (GIS) mapping to depict geographic variation in prescribing by county. Oral antibiotic prescriptions were compared across CY 2018 and 2019 including spectrum of antibiotic coverage. Results In CY 2018, 204,576 pediatric patients received 237,759 antibiotics (1,162 prescriptions/1,000 children). In 2019, 201,520 pediatric patients received 227,440 antibiotics (1,129 prescriptions/1,000 children). Prescription rates were higher among females, Caucasians and a younger (0-2) age group (Table 1). Antibiotics were more commonly prescribed by non-physician (e.g. nurse practitioner, etc.), non-pediatric specialty providers. Amoxicillin, cefdinir, and azithromycin were the most commonly prescribed antibiotics across CYs. Table 2 summarizes commonly prescribed antibiotics and their associated cost. Medicaid region 4 encompassed the highest prescription rates. Figure 1 is a GIS map of prescription rates by WV county. Table 1. West Virginia pediatric (0 – 19 years*) Medicaid patient population demographic summary by calendar year (CY). Table 2. Oral antibiotic prescription review including cost, CY 2018-2019. Figure 1. Geographic information system (GIS) mapping of prescriptions per 1,000 children by WV county. Conclusion There is significant variation in antibiotic prescribing across WV. Potential areas of stewardship intervention should focus on non-physician, non-pediatric providers in Medicaid Region 4, the southern and arguably most rural portion of the state. Secondary analysis revealed an alarmingly high total number of broad-spectrum antibiotic use compared to narrow-spectrum. Further data analysis will examine diagnosis-specific prescription practices within this population. Disclosures Michael J. Smith, MD, MSC.E, Kentucky Medicaid (Grant/Research Support)Merck (Grant/Research Support)

Education and the University of North Carolina Pre-Flight School

Home Front ◽  
2017 ◽  
Keyword(s):  
United States ◽  
North Carolina ◽  
Military Training ◽  
The United States ◽  
Colleges And Universities ◽  
The State ◽  
Chapel Hill ◽  
Trained Teachers ◽  
The University ◽  
The U.S

Primary and secondary schools were hard hit by the war, with a dearth of supplies and trained teachers. Many colleges and universities, vacated by men off to war, would have had to close were it not for the U.S. military training units at the schools. Each institution in the state had some sort of government activity on their campuses, but the preeminent center was the Navy Pre-Fight School at UNC-Chapel Hill, where two future presidents of the United States, George H. W. Bush and Gerald Ford trained.

scholarly journals Outpatient Antibiotic Prescribing in Massachusetts, 2011–2015

2019 ◽  
Vol 6 (5) ◽  
Author(s):  
R Monina Klevens ◽  
Evan Caten ◽  
Scott W Olesen ◽  
Alfred DeMaria ◽  
Scott Troppy ◽  
...  
Keyword(s):  
Anatomical Therapeutic Chemical ◽  
Local Population ◽  
Antibiotic Use ◽  
Population Based ◽  
The State ◽  
World Health ◽  
Antibiotic Prescribing ◽  
Census Tracts ◽  
Outpatient Prescription ◽  
Ongoing Surveillance

Abstract Background The objectives of this study were to develop methods to measure population-based outpatient antibiotic prescribing in Massachusetts and to describe the findings as a first step toward institution of ongoing surveillance. Methods We analyzed outpatient prescription claims from the Massachusetts All-Payers Claims Database from 2011 to 2015. We grouped claims for antibiotics according to the World Health Organization’s Anatomical Therapeutic Chemical Classification System using the National Library of Medicine’s RXNorm database. We grouped prescribers into 17 specialties. Antibiotic use rates were calculated, and simple frequencies were used to describe patterns. Results The overall annual rate of outpatient antibiotic use for individuals aged 0–64 years was 696 prescriptions per 1000 people. During 2015, 68% of people in Massachusetts had no antibiotic prescription, and 17% had only 1 prescription. There was dramatic variability in antibiotic use rates by census tract within the state (rates of penicillin use ranged from 31 to 265 prescriptions per 1000 people, macrolides from 28 to 333, cephalosporins from 8 to 89, quinolones from 13 to 118). Antibiotic use rates were generally lower in urban census tracts. From 2011 to 2015, there was a 17% decline in antibiotic prescribing, with the greatest decline for macrolides (28%). Conclusions There was variability in antibiotic prescribing within Massachusetts by age, sex, and antibiotic class. Variation in antibiotic use across census tracts within the state was similar to the variation in use across US states. Continued measurement and detailed local population rates of antibiotic use in Massachusetts will provide feedback for local prescribers.

scholarly journals 1099. Antibiotic Prescriptions for Acute Gastroenteritis during Office and Emergency Department Visits–United States, 2006–2015

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S330-S330
Author(s):  
Jennifer P Collins ◽  
Louise Francois Watkins ◽  
Laura M King ◽  
Monina Bartoces ◽  
Katherine Fleming-Dutra ◽  
...  
Keyword(s):  
United States ◽  
Emergency Department ◽  
Medical Care ◽  
Acute Gastroenteritis ◽  
Antibiotic Use ◽  
The United States ◽  
Emergency Department Visits ◽  
Antibiotic Prescribing ◽  
Care Survey ◽  
Ambulatory Medical Care

Abstract Background Acute gastroenteritis (AGE) is a major cause of office and emergency department (ED) visits in the United States. Most patients can be managed with supportive care alone, although some require antibiotics. Limiting unnecessary antibiotic use can minimize side effects and the development of resistance. We used national data to assess antibiotic prescribing for AGE to target areas for stewardship efforts. Methods We used the 2006–2015 National Hospital Ambulatory Medical Care Survey of EDs and National Ambulatory Medical Care Survey to describe antibiotic prescribing for AGE. An AGE visit was defined as one with a new problem (<3 months) as the main visit indication and an ICD-9 code for bacterial or viral gastrointestinal infection or AGE symptoms (nausea, vomiting, and/or diarrhea). We excluded visits with ICD-9 codes for Clostridium difficile or an infection usually requiring antibiotics (e.g., pneumonia). We calculated national annual percentage estimates based on weights of sampled visits and used an α level of 0.01, recommended for these data. Results Of the 12,191 sampled AGE visits, 13% (99% CI: 11–15%) resulted in antibiotic prescriptions, equating to an estimated 1.3 million AGE visits with antibiotic prescriptions annually. Antibiotics were more likely to be prescribed in office AGE visits (16%, 99% CI: 12–20%) compared with ED AGE visits (11%, 99% CI: 9–12%; P < 0.01). Among AGE visits with antibiotic prescriptions, the most frequently prescribed were fluoroquinolones (29%, 99% CI: 21–36%), metronidazole (18%, 99% CI: 13–24%), and penicillins (18%, 99% CI: 11–24%). Antibiotics were prescribed for 25% (99% CI: 8–42%) of visits for bacterial AGE, 16% (99% CI: 12–21%) for diarrhea without nausea or vomiting, and 11% (99% CI: 8–15%) for nausea, vomiting, or both without diarrhea. Among AGE visits with fever (T ≥ 100.9oF) at the visit, 21% (99% CI: 11–31%) resulted in antibiotic prescriptions. Conclusion Patients treated for AGE in office settings were significantly more likely to receive prescriptions for antibiotics compared with those seen in an ED, despite likely lower acuity. Antibiotic prescribing was also high for visits for nausea or vomiting, conditions that usually do not require antibiotics. Antimicrobial stewardship for AGE is needed, especially in office settings. Disclosures All authors: No reported disclosures.

scholarly journals Nonprescription Antimicrobial Use in a Primary Care Population in the United States

2016 ◽  
Vol 60 (9) ◽  
pp. 5527-5532 ◽  
Author(s):  
Roger Zoorob ◽  
Larissa Grigoryan ◽  
Susan Nash ◽  
Barbara W. Trautner
Keyword(s):  
United States ◽  
Primary Care ◽  
Random Sample ◽  
Latin American ◽  
Patient Characteristics ◽  
Antibiotic Use ◽  
Multivariate Regression Analysis ◽  
The United States ◽  
Race Ethnicity ◽  
Intended Use

ABSTRACTCommunity antimicrobial resistance rates are high in communities with frequent use of nonprescription antibiotics. Studies addressing nonprescription antibiotic use in the United States have been restricted to Latin American immigrants. We estimated the prevalence of nonprescription antibiotic use in the previous 12 months as well as intended use (intention to use antibiotics without a prescription) and storage of antibiotics and examined patient characteristics associated with nonprescription use in a random sample of adults. We selected private and public primary care clinics that serve ethnically and socioeconomically diverse patients. Within the clinics, we used race/ethnicity-stratified systematic random sampling to choose a random sample of primary care patients. We used a self-administered standardized questionnaire on antibiotic use. Multivariate regression analysis was used to identify independent predictors of nonprescription use. The response rate was 94%. Of 400 respondents, 20 (5%) reported nonprescription use of systemic antibiotics in the last 12 months, 102 (25.4%) reported intended use, and 57 (14.2%) stored antibiotics at home. These rates were similar across race/ethnicity groups. Sources of antibiotics used without prescriptions or stored for future use were stores or pharmacies in the United States, “leftover” antibiotics from previous prescriptions, antibiotics obtained abroad, or antibiotics obtained from a relative or friend. Respiratory symptoms were common reasons for the use of nonprescription antibiotics. In multivariate analyses, public clinic patients, those with less education, and younger patients were more likely to endorse intended use. The problem of nonprescription use is not confined to Latino communities. Community antimicrobial stewardship must include a focus on nonprescription antibiotics.

scholarly journals Rural-Urban Disparities in Place of Death in Hematologic Malignancies in the US from 2003 to 2019

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4137-4137
Author(s):  
Syed M. Qasim Hussaini ◽  
Arjun Gupta
Keyword(s):  
United States ◽  
Metropolitan Area ◽  
Rural Areas ◽  
Hospice Care ◽  
Metropolitan Areas ◽  
Hematologic Malignancies ◽  
The United States ◽  
Medical Facility ◽  
Nursing Facility ◽  
The Us

Abstract Background: more than 60,000 people die annually from hematologic malignancies in the united states (us). Patients with hematologic malignancies more frequently receive aggressive care toward the end-of-life and are more likely to die in a hospital compared to those with a solid tumor. Appropriate care of such patients is very dependent on an existing healthcare infrastructure. There are notable challenges to rural healthcare in the united states which contains less than 1/5th of all hospices in the us. In this study, we sought to investigate rural-urban disparities in place of death the us in individuals that died from hematologic malignancies. Methods: we utilized the us centers for disease control and prevention wide-ranging online data for epidemiologic research database to analyze all deaths from hematologic malignancies in the us from 2003 to 2019. A population classification utilizing the 2013 us census was made using the national center for health statistics urban-rural classification scheme. These classifications included: large metropolitan area (1 million), small- or medium-sized metropolitan area (50 000-999 999), and rural area (<50 000). We estimated deaths in a medical facility, hospice, home, or nursing care facility. We stratified the results by age, sex, and race/ethnicity. The annual percentage change (apc) in deaths was estimated. All data was publicly available and de-identified. Findings: from 2003-2019, there were a total 1,088,589 deaths form hematologic malignancies in the united states, predominantly in large metropolitan areas (50.2%), followed by small or medium sized metropolitan areas (31.7%) and rural areas (18.2%). All regions noted decreases in medical facility and nursing facility related deaths, and increase in hospice and home deaths. While rural areas demonstrated the quickest uptake of hospice care (apc 61.5), they had the lowest overall presence of hospice care (8.3% of all rural deaths in 2019 vs. 14.9% for small or medium metropolitan vs. 12% for large metropolitan) and larger share of nursing facility related deaths (15.8% of all rural deaths in 2019 vs 12.3% for small or medium metropolitan vs 10.6% for large metropolitan). Discussion: we demonstrate end-of-life disparities in hematologic malignancies based on where an individual resides in the us with rural areas having notably lower share of deaths in hospice facilities. Older infrastructure, inadequate access to care, and financial barriers add to the medical complexity of care for all patients, and especially hematologic patients with high needs and complex treatment planning. These have been aggravated by rural hospital closures in the previous 18 months. The us senate is currently debating a bipartisan infrastructure that may add billions in building rural healthcare infrastructure to state budgets. Our findings are timely in helping inform congressional policy. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

scholarly journals Role of Disease-Specific Incidence and Survival in Disparities in Life Expectancy in the United States

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 149-149
Author(s):  
Julia Kravchenko ◽  
Bin Yu ◽  
Igor Akushevich
Keyword(s):  
United States ◽  
Lung Cancer ◽  
Life Expectancy ◽  
Racial Disparities ◽  
Disease Incidence ◽  
The United States ◽  
The State ◽  
The Us ◽  
Race Ethnicity ◽  
Disease Specific

Abstract There are persisting geographic and racial disparities in life expectancy (LE) across the United States (US). We used 5% Medicare Claims data (2000-2017) to investigate how disease incidence and survival contribute to such disparities. Disease-specific hazard ratios (HRs) were calculated for Medicare beneficiaries living in the US states with the lowest LE (the states with the highest LE were used as a reference group), in gender- and race-/ethnicity-specific populations. Analysis of incidence showed that the greatest contribution to between-the-state disparities in LE was due to higher incidence (HRs≥1.30) of atherosclerosis, heart failure, influenza/pneumonia, Alzheimer’s disease, and lung cancer among older adults living in the states with the lowest LE. The list of diseases that contributed most to LE through the differences in their survival substantially differed from the above listed diseases: namely, diabetes, chronic ischemic heart disease, and cerebrovascular disease had HRs≥1.28 for their respective survival rates, with the highest HRs for lung cancer (HR=1.37, in females) and prostate cancer (HR=1.30). Respective race-/ethnicity-specific patterns of incidence and survival HRs were investigated and diseases contributed most to racial disparities in LE were identified. Study showed that when planning the strategies targeting between-the-state differences in LE in the US, it is important to address both 1) primary and secondary prevention for diseases demonstrating substantial differences in contributions of incidence, and 2) treatment choice, adherence to treatment, and comorbidities for diseases contributing to LE disparities predominantly through the differences in survival. Such strategies can be disease-, race-/ethnicity-, and geographic area-specific.

scholarly journals 412. Estimating the Impact of School Classroom Sizes on the Probability of Severe Acute Respiratory Syndrome Coronavirus-2 Infectivity or Exposure

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S307-S307
Author(s):  
Sanya J Thomas ◽  
Rebecca R Young ◽  
Ibukunoluwa Akinboyo ◽  
Michael J Smith ◽  
Tara Buckley ◽  
...  
Keyword(s):  
North Carolina ◽  
Severe Acute Respiratory Syndrome ◽  
Reproduction Number ◽  
The United States ◽  
Mitigation Strategies ◽  
Age Group ◽  
Cohort Size ◽  
Research Support ◽  
The Impact

Abstract Background Despite schools reopening across the United States in communities with low and high Coronavirus disease 2019 (COVID-19) prevalence, data remain scarce about the effect of classroom size on the transmission of severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) within schools. This study estimates the effect of classroom size on the risk of COVID-19 infection in a closed classroom cohort for varying age groups locally in Durham, North Carolina. Total number of Coronavirus Disease 2019 (COVID-19) infections over a 28-day follow-up period for varying classroom reproduction number (R0) and varying classroom cohort sizes of 15 students, 30 students and 100 students in Durham County, North Carolina. Methods Using publicly available population and COVID-19 case count data from Durham County, we calculated a weekly average number of new confirmed COVID-19 cases per week between May 3, 2020 and August 22, 2020 according to age categories: < 5 years, 5-9 years, 10-14 years, and 15-19 years. We collated average classroom cohort sizes and enrollment data for each age group by grade level of education for the first month of the 2019-2020 academic school year. Then, using a SEIR compartmental model, we calculated the number of susceptible (S), exposed (E), infectious (I) and recovered (R) students in a cohort size of 15, 30 and 100 students, modelling for classroom reproduction number (R0) of 0.5, 1.5 and 2.5 within a closed classroom cohort over a 14-day and 28-day follow-up period using age group-specific COVID-19 prevalence rates. Results The SEIR model estimated that the increase in cohort size resulted in up to 5 new COVID-19 infections per 10,000 students whereas the classroom R0 had a stronger effect, with up to 88 new infections per 10,000 students in a closed classroom cohort over time. When comparing different follow-up periods in a closed cohort with R0 of 0.5, we estimated 12 more infected students per 10,000 students over 28 days as compared to 14 days irrespective of cohort size. With a R0 of 2.5, there were 49 more infected students per 10,000 students over 28 days as compared to 14 days. Conclusion Classroom R0 had a stronger impact in reducing school-based COVID-19 transmission events as compared to cohort size. Additionally, earlier isolation of newly infected students in a closed cohort resulted in fewer new COVID-19 infections within that group. Mitigation strategies should target promoting safe practices within the school setting including early quarantine of newly identified contacts and minimizing COVID-19 community prevalence. Disclosures Michael J. Smith, MD, M.S.C.E, Merck (Grant/Research Support)Pfizer (Grant/Research Support)

scholarly journals Influence of Characteristics of Metropolitan Areas on the Logistics Sprawl: A Case Study for Metropolitan Areas of the State of Paraná (Brazil)

2020 ◽  
Vol 12 (22) ◽  
pp. 9779
Author(s):  
Luísa Tavares Muzzi de Sousa ◽  
Leise Kelli de Oliveira
Keyword(s):  
Metropolitan Area ◽  
Metropolitan Areas ◽  
Negative Relationship ◽  
Freight Transport ◽  
The State ◽  
Urban Freight ◽  
Time Period ◽  
Urban Freight Transport ◽  
Data Collection Procedure

The concentration of warehouses in peripheral regions of metropolitan areas in a time period is called logistics sprawl (LS). Identifying this phenomenon could help to reduce externalities related to urban freight transport, mainly, the distance traveled. This paper examines the contribution of the characteristics of metropolitan areas on the logistics sprawl indicator. A case study was carried out considering data from eight metropolitan areas of the state of Paraná (Brazil). The research method is based on the data collection procedure proposed, centrographic method, and linear regression. The results of the centrographic method reveal a positive LS in four metropolitan areas and a negative LS in three metropolitan areas. In general, the warehouses are close to the highways that cross the metropolitan area. In addition, the size of the metropolitan area has a negative relationship with the number of warehouses and the logistics sprawl indicator. The findings highlight the importance of public policies relating to urban freight transport and land use at a metropolitan level.

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