Antibiotic resistance is an emerging global public health threat, recognized by the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). Combating and reducing the rate antimicrobial resistance requires collaboration between public health entities and clinicians. The CDC recognizes tracking and reporting of antibiotic prescribing practices as one of the core elements of antibiotic stewardship in outpatient settings (Core Elements). The CDC Morbidity and Mortality Weekly Report (MMWR), “Identifying Higher-Volume Antibiotic Outpatient Prescribers Using Publicly Available Medicare Part D Data — United States, 2019” outlines the utility of publicly available Medicare Part D data to “guide antibiotic stewardship interventions and optimize antibiotic prescribing.”
Prescribers in Hawaiʻi have varying levels of antibiotic usage, which the Centers for Medicare and Medicaid Services (CMS) publishes annually with a two-year lag. We analyzed Hawaiʻi’s primary care providers (PCP) in the Public Use File (PUF) “Medicare Part D Prescribers – by Provider” to determine the highest 10% of antibiotic prescribers by volume (CMS PUF). We evaluated the use of specific antibiotic classes of interest by multiple metrics including cost per beneficiary, antibiotics per beneficiary while controlling for provider demographic characteristics (gender, specialty, county, geography) and overall patient volume (total annual beneficiaries). Many jurisdictions have conducted similar analyses and stewardship initiatives including Tennessee and Minnesota. Read more about the methodology and results in the 2-page summary of the project, “Analysis of Medicare Part D Data to Identify High-Volume Antibiotic Prescribers among Primary Care Providers in Hawaiʻi.”
Antibiotic Volume Feedback Letters
After higher-volume prescribers were identified, feedback letters were created for the top 10% of antibiotic prescribers by volume, that fall within internal medicine and family practice. Medicare data does not include information on diagnostics, and therefore appropriateness was not assessed. Rather, those within the 90th percentile for antibiotics by volume were identified, and within that cohort, the percentile of macrolide volume, fluoroquinolone volumes, and active MRSA drug volume were determined.
Stewardship Resources
We encourage you to consider the following resources and tools to optimize antibiotic prescribing.
- Register for the free Hawaiʻi Antimicrobial Stewardship Collaborative (HASC) meetings for acute care settings and LTCFs by emailing Garret Hino Jr., PharmD, BCIDP, Public Health Pharmacist at [email protected].
- Communicate to patients why antibiotics are not needed for certain infections – you can use the CDC factsheet: Viruses or Bacteria: What’s got you sick?
- Take the Training on Antibiotic Stewardship | CDC to learn more about appropriate antibiotic use.
Stewardship Updates
- Review the 2023 Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.
- Stay up to date any FDA warnings or alerts regarding fluroquinolone use.
- Familiarize your clinic and staff with CDC’s Core Elements of Outpatient Antibiotic Stewardship.
Feedback Letter Survey
If you received a letter regarding your outpatient antibiotic prescribing volume, we encourage you to take a survey to provide feedback on the initiative. Please scan the QR code on your individualized letter in order to participate.