• Nick Daneman, Michael A Campitelli, Vasily Giannakeas, Andrew M Morris, Chaim M Bell, Colleen J Maxwell, Lianne Jeffs, Peter C Austin, and Susan E Bronskill.
• Institute for Clinical Evaluative Sciences (Daneman, Campitelli, Giannakeas, Bell, Maxwell, Austin, Bronskill), Toronto, Ont.; Sunnybrook Research Institute and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Daneman, Morris, Bell); Institute of Health Policy, Management and Evaluation (Daneman, Bell, Austin, Bronskill); Sinai Health System (Morris, Bell); St. Michael's Hospital (Jeffs), University of Toronto, Toronto, Ont.; University of Waterloo (Maxwell), Waterloo, Ont. nick.daneman@sunnybrook.ca.
• CMAJ. 2017 Jun 26; 189 (25): E851-E860.

BackgroundUnderstanding the extent to which current antibiotic prescribing behaviour is influenced by clinicians' historical patterns of practice will help target interventions to optimize antibiotic use in long-term care. Our objective was to evaluate whether clinicians' historical prescribing behaviours influence the start, prolongation and class selection for treatment with antibiotics in residents of long-term care facilities.MethodsWe conducted a retrospective cohort study of all physicians who prescribed to residents in long-term care facilities in Ontario between Jan. 1 and Dec. 31, 2014. We examined variability in antibiotic prescribing among physicians for 3 measures: start of treatment with antibiotics, use of prolonged durations exceeding 7 days and selection of fluoroquinolones. Funnel plots with control limits were used to determine the extent of variation and characterize physicians as extreme low, low, average, high and extreme high prescribers for each tendency. Multivariable logistic regression was used to assess whether a clinician's prescribing tendency in the previous year predicted current prescribing patterns, after accounting for residents' demographics, comorbidity, functional status and indwelling devices.ResultsAmong 1695 long-term care physicians, who prescribed for 93 132 residents, there was wide variability in the start of antibiotic treatment (median 45% of patients, interquartile range [IQR] 32%-55%), use of prolonged treatment durations (median 30% of antibiotic prescriptions, IQR 19%-46%) and selection of fluoroquinolones (median 27% of antibiotic prescriptions, IQR 18%-37%). Prescribing tendencies for antibiotics by physicians in 2014 correlated strongly with tendencies in the previous year. After controlling for individual resident characteristics, prior prescribing tendency was a significant predictor of current practice.InterpretationPhysicians prescribing antibiotics exhibited individual, measurable and historical tendencies toward start of antibiotic treatment, use of prolonged treatment duration and class selection. Prescriber audit and feedback may be a promising tool to optimize antibiotic use in long-term care facilities.© 2017 Canadian Medical Association or its licensors.

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