Association between clinician distress and inappropriate use of antibiotic prescriptions

OAKBROOK TERRACE - The overprescribing of antibiotics in U.S. outpatient settings is an urgent public health concern.

The majority of these antibiotic prescriptions are written for acute respiratory tract infections (RTIs), even though antibiotics are inappropriate for treating viral RTIs such as bronchitis, sore throats, common colds and the flu.

A new study from the May 2022 issue of The Joint Commission Journal on Quality and Patient Safety, "Clinician Distress and Inappropriate Antibiotic Prescribing for Acute Respiratory Tract Infections: A Retrospective Cohort Study," examined the association between clinician distress and the inappropriate use of antibiotic prescriptions for acute RTIs in adult outpatients.

The researchers evaluated electronic health record visit data linked to annual wellness surveys administered to all clinicians at Boston Medical Center, Boston. Outpatient visits included those in family medicine, general internal medicine and the emergency department where an acute RTI for an otherwise healthy adult was listed as a primary diagnosis.

Clinician depression, anxiety and burnout were assessed using the National Institutes of Health Patient Report Outcomes Measurement Information System and the Stanford Professional Fulfillment Index Burnout Composite scale obtained from clinician wellness survey data collected up to six months prior to a patient visit.

Overall, approximately 34% and 50% of clinicians in the study reported depression/anxiety and burnout symptoms, respectively. Findings showed each one standard deviation increase in a clinician's composite depression and anxiety score was associated with a 28% increase in the odds of an inappropriate antibiotic prescription for an acute RTI. Clinician burnout had no significant association with inappropriate antibiotic prescribing.

"Although the current study was conducted in the pre-COVID-19 era, it is plausible that had this work been repeated during the height of the pandemic, the unique stressor imposed by the COVID-19 pandemic would have shown an even greater prevalence of depression and/or anxiety among clinicians," notes an accompanying editorial by Sara C. Keller, MD, MSHP and Pranita D. Tamma, MD, MHS. "We applaud Brady and colleagues for shedding light on an important and unrecognized area in need of intervention - the impact of provider mental health on inappropriate antibiotic prescribing."

For more information on health care worker well-being, please access The Joint Commission's Quick Safety, Issue 50: Developing resilience to combat nurse burnout and the National Academy of Medicine's Resource Compendium for Healthcare Worker Well-Being.