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)
West Virginia Education Information System users' concerns as measured by the Stages of Concern Questionnaire
