ABSTRACT
Background. Outpatient antibiotic (OP Abx) prescribing in adults in Arkansas (AR) was among the country's highest in 2019. AR Medicaid analyzed prescription (Rx) claims data and communicated the relative prescribing intensity as an informational metric to each patient-centered medical home (PCMH) beginning in 2020. We describe the Abx prescribing patterns in calendar years 2019 and 2020, during the COVID-19 pandemic. Methods. Data from AR Medicaid paid claims for OP Abx Rxs in adult patients attributed to a PCMH practice for > 6 months were analyzed. Annual Abx Rx claims per 1000 patients were calculated for rural or urban status and by 2019 prescribing rate histories, defined as the low-,middle-, and high-rate prescribers based on 1st, 2nd - 3rd, & 4th quartiles, respectively. The five most common classes in 2019 and fluoroquinolones were explored.A paired t-test, Wilcoxon signed rank test, and one-wayANOVA with post hoc least significant difference test were used to determine statistical significance. Results. 183 PCMHs qualified for analysis. There was a significant decrease in overall annual Abx claim rate, from 1034 to 910 (-12.0%, p< 0.0001). Claim rates decreased in rural (-10.9%, p< 0.0001) and urban areas (-13.3%, p< 0.0001) with no difference between groups (p=0.240). Low-rate prescribers did not change practice from 2019 to 2020, with claim rates of 666 to 665 (-0.2%, p=0.957), while middle- and highrate prescribers decreased, from 1032 to 897 (-13.1%, p< 0.0001), and from 1404 to 1183 (-15.7%, p< 0.0001), respectively. Claim rates significantly decreased for penicillins (-16.0%, p< 0.0001), fluoroquinolones (-15.5%, p< 0.0001), sulfonamides (-13.1%, p< 0.0001), macrolides (-9.9%, p=0.0001), and tetracyclines (-6.3%, p=0.021). First-generation cephalosporins down trended (-7.9%, p=0.111). Conclusion. OP Abx Rx claims significantly decreased from 2019 to 2020 in middle and high-rate prescribers. Low-rate prescribers maintained low Abx Rx claim rates throughout 2020. Future analyses are needed to highlight any rebound effect of Abx prescribing when the pandemic subsides, discerning the informational metric effect versus COVID-19, and informing the next steps for antimicrobial stewardship for PCMHs in AR.
ABSTRACT
Introduction: In 2020, the COVID pandemic altered care patterns throughout health care. Routine office and ER visits declined and antibiotic prescribing changed as a consequence. Research Question or Hypothesis: How did the COVID pandemic affect outpatient antibiotic prescribing in an Arkansas Medicaid population? Study Design: Descriptive statistics were used to determine the impact of the COVID pandemic on outpatient antibiotic prescribing in Arkansas Medicaid patients. Methods: Antibiotic pharmacy claims were extracted from the Arkansas Medicaid prescription claims database for calendar years 2018 through 2021. The monthly total number of antibiotic claims from January 2018 through December 2021 were calculated. Monthly data from 2018 and 2019 were averaged to create a baseline. The average percent change in the number of outpatient antibiotic claims from February 2018-2019 to April 2018-2019 was compared to the percent change from February 2020 to April 2020. Additional percent change was calculated as the difference between the 2018-2019 average percent change and the 2020 observed percent change among all ages and prespecified age-groups. Results: The seasonal (February-April) drop in antibiotic prescriptions pre-pandemic was -18%, from 52,000 to 42,750 per month. In February-April 2020, claims fell an additional 42% (-60% in 2020, from 49,020 to 19,640). Age-related decreases showed claims for patients <5 years dropped an additional 54% from baseline;5-17 years, 48%;and >18 years, 20%. Antibiotic prescriptions in April 2021 (∼34,000) rebounded to approach the pre-pandemic baseline of 42,750. Conclusion: Outpatient antibiotics prescription claims declined sharply from baseline, especially in children, in 2020 during the COVID pandemic. Potential reasons may be attributed to clinic avoidance, more viral than bacterial illnesses, or less illness due to masking and distancing;however, the degree attributed to each has not been determined. A return to baseline was observed in 2021. Continued efforts in antibiotic stewardship are warranted.