Study: Doctors call in more antibiotics without exams
By Rita Rubin, USA TODAY
Created: 12/6/2006 10:56:47 AM
Updated: 12/6/2006 10:57:58 AMPrescribing antibiotics has become so common that many doctors literally are just phoning it in, a new analysis of insurance claims suggests.
Prescribing antibiotics has become so common that many doctors literally are just phoning it in, a new analysis of insurance claims suggests.
Researchers found that 40% of people who filled an antibiotic prescription had not seen a doctor in at least a month, raising the possibility that their symptoms were the result of a viral infection, which doesn't respond to antibiotics, instead of a bacterial infection, which does.
Though antibiotics generally are benign, overprescribing has helped produce drug-resistant "superbugs."
"The study is just a broad indicator of too great a willingness to prescribe," says author William Marder, senior vice president and general manager of Thomson Medstat, a health care information company based in Ann Arbor, Mich.
Thomson Medstat analyzed 1.5 million insurance claims for antibiotic prescriptions in 2004 - the most recent information available - for children and adults under 65 covered by an employer health plan.
Marder called for new treatment guidelines for doctors who increasingly are likely to evaluate patients by phone and the Internet. "It will be critical for physicians to develop the skills necessary to communicate effectively with patients" they can't examine, he writes.
Already, though, says Dartmouth pediatrics professor James Sargent, there are many situations where doctors call in antibiotic prescriptions and refills "without cause for alarm."
For example, Sargent said via e-mail, his practice often calls in prescriptions for antibiotic drops for pinkeye and pills for sore throats in people who have a family member diagnosed with strep throat.
Randall Stafford, associate professor at Stanford's Prevention Research Center, acknowledges that phoned-in antibiotic prescriptions are OK in some situations, such as for women with a repeat urinary tract infection. Still, he called Marder's findings "concerning."
"The standard of care is to have adequate information to make reliable decisions," Stafford says. "Usually, that requires a physical exam."