Physician antimicrobial prescribing and patient outcomes on general medical wards: a multicentre retrospective cohort study
10 August 2023
We attributed patient-days to physicians using cine wards.15 Further, antimicrobial use is common on general the Canadian Institute for Health Information (CIHI) definition for medicine wards, with about 30% of patients receiving antimicro- an MRP (i.e., “responsible for the care and treatment of the bial therapy.16,17 patient for the majority of the visit to the health care facility”).22 We sough. [...] understanding of variability in the spectrum of antibacterial pre- scribing, we used a modified tool that was initially developed to Sensitivity analyses help quantify the relative spectrum of antibacterial agents for We performed several sensitivity analyses to evaluate whether patients in the ICU.28,32 Spectrum of activity refers to the relative patient-level factors influenced physician-level a. [...] These are To minimize the potential for misattribution of MRP status widely used outcomes in health systems research and are par- and antimicrobial prescribing, we conducted an analysis restrict- ticularly useful for assessment of antimicrobial prescribing, ing inclusion to patients who were admitted to and discharged as infection and treatment may lead to changes in these from the general medicin. [...] *Days of therapy standardized to 100 patient-days of each prescriber’s service, which reflects an aggregate quantity of antimicrobial prescribing.31 For each physician in the study, we calculated all antimicrobials prescribed by that physician for their patients into days of therapy and then standardized to the volume of patients seen by each physician. [...] The positive association between the intensity For outcomes analyses, we did not observe significant differ- of antimicrobials prescribed (measured by the modified spectrum ences by quartile when the cohort was restricted to patients score) and odds of in-hospital mortality is unexpected and may admitted to and discharged from the same MRP and when be caused by an actual association, unmeasured co.