| The inappropriate and excessive use of antibiotics has been noted to be a major cause of bacterial resistance. While there is extensive data that describes the prescriptive behaviors of physicians, there is a paucity of data on the antibiotic prescribing patterns of advanced practice nurses, such as nurse practitioners, that possess prescriptive authority.; The purpose of this study was to describe and predict factors that are associated with antibiotic prescribing by nurse practitioners and physicians for viral upper respiratory infections in the ambulatory setting and to suggest nurse practitioner specific policy and training initiatives related to the judicious use of antibiotics. The study utilized a cross-sectional retrospective design of data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) and the National Ambulatory Medical Care Survey (NAMCS) between 1997 and 2001. Data were collected on a national probability sample of 506 nurse practitioner (NP) and 13,692 physician (MD) visits for viral upper-respiratory tract infections (URIs, viral pharyngitis, and bronchitis).; Results of bivariate analysis found no differences in antibiotic prescribing for viral upper respiratory tract infections by NPs (50.4%) and MDs (53%). Broad-spectrum antibiotics accounted for 36.6% of the NP antibiotic prescriptions and for 33.2% of the MD antibiotic prescriptions.; Multivariate analysis identified several clinical and non-clinical factors that are associated with NP antibiotic prescribing. After adjusting for co-morbidity, the strongest independent predictors of NP antibiotic prescribing for viral illness were Black race, (Odds Ratio (OR) 3.47; 95% Confidence Interval (CI), 1.01--11.8); Medicaid insurance, OR 0.26, CI 0.09--0.74; Northeast region, OR 9.2, CI 2.5--33.9; viral pharyngitis, OR 3.7, CI 1.7--8.09; and bronchitis, OR 15.4, CI 4.8--62.5. The strongest predictors of MD prescribing were viral pharyngitis, OR 3.2, CI 2.7--3.8; bronchitis OR 3.2, CI 2.6--3.8; and non-antibiotic prescription, OR 0.6, CI 0.5--0.8.; The excessive and inappropriate use of antibiotics by both nurse practitioners and physicians suggests the continuing need for educational initiatives such as "academic detailing" directed to nurse practitioners and physicians as well as increasing involvement in the dissemination of clinical guidelines and system based quality assurance programs. Also, the decreased likelihood by NPs to prescribe antibiotics to patients with Medicaid insurance suggests more appropriate, cost-effective care in this population. Overall, the strong association of non-clinical factors suggests the need for awareness and improvement of prescribing decisions by both nurse practitioners and physicians. |
