Outpatient Antibiotic Prescribing, Dispensing and Susceptibility Testing in a Primary Care Spinal Cord Injury Cohort
Individuals with spinal cord injuries (SCI) frequently experience infections, such as urinary tract infections (UTIs), pressure ulcers and respiratory infections and as a result may frequently use antibiotics. Little research has been conducted on outpatient antibiotic prescribing in the SCI population, especially in primary care. The objectives of this thesis in a cohort of individuals with SCI rostered to a primary care physician (PCP) are to: 1) examine primary care antibiotic prescribing patterns; 2) determine patterns of urine culture susceptibility testing for UTI indicated antibiotic prescriptions; and 3) identify who prescribes outpatient antibiotics. This was a retrospective cohort study using linked electronic medical records and health administrative databases from Ontario. Study 1 described patterns of primary care antibiotic prescribing in a primary care rostered- SCI cohort of 432 individuals and found UTIs were the number one indication for prescriptions. Catheter use was found to be associated with number of antibiotics prescribed, and PCP years of practice was associated with prescription duration. Study 2, identifying urine culture testing and antibiotic prescribing patterns for UTIs in 432 individuals with SCI, found 58.1% of UTI-indicated antibiotic prescriptions were linked to a urine culture. Early-career physicians were more likely to order a urine culture when prescribing an antibiotic. Male physicians and international medical graduates were more likely to prescribe fluoroquinolone, than nitrofurantoin for UTIs. Study 3 identifies who prescribed outpatient antibiotics based on physician speciality for 320 individuals with SCI, who receive support from a drug benefit program. Nearly 60% of antibiotics were prescribed by physicians in an individual’s rostered-primary care practice, compared to 17.9% by emergency and non-rostered primary care physicians. Those who lived in urban and rural areas compared to suburban were more likely to receive antibiotics from emergency and non-rostered primary care physicians than physicians in their rostered-primary care practice. Results from these studies provide a better understanding of patterns of outpatient antibiotic prescribing and susceptibility testing in the SCI population, and can be used to inform future research, as well as develop antibiotic prescribing optimization strategies.
Antibiotic Prescribing, Electronic Medical Records, Primary Care, Spinal Cord Injury, Urine Cultures
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