{
  "abstract": "Objective To assess the prevalence and associated factors of inappropriate antibiotic prescribing in Japanese primary care.Methods This cross-sectional study analysed all antibiotic prescriptions written between 1 October 2022 and 30 September 2023, using an electronic health record database of primary care clinics across Japan. Using a previously developed classification algorithm, we determined whether diagnosis codes occurring on or during the 3 days before the antibiotic prescribing date ‘always’, ‘sometimes’ or ‘never’ justified antibiotic use. We classified antibiotic prescriptions into one of four mutually exclusive categories: ‘appropriate’ (associated with ≥1 ‘always’ code), ‘potentially appropriate’ (associated with ≥1 ‘sometimes’ code but no ‘always’ codes), ‘inappropriate’ (associated only with ‘never’ codes) and ‘not associated with a recent diagnosis’. A linear probability model examined patient, physician and visit characteristics associated with inappropriate antibiotic prescribing among solo practice clinics.Results Analyses included 2 058 021 outpatient antibiotic prescriptions to 1 267 708 patients at 2809 clinics. Among these prescriptions, 176 181 (8.6%) were appropriate, 1 238 549 (60.2%) were potentially appropriate, 348 949 (17.0%) were inappropriate and 294 342 (14.3%) were not associated with a recent diagnosis. Among solo practice clinics, inappropriate prescribing was more likely to patients aged <18 versus ≥65 years (+2.6%; 95% CI +0.3% to +4.9%) or with Charlson Comorbidity Index score ≥2 vs 0 (+2.0%; 95% CI +0.6% to +3.4%), for physicians aged ≥65 versus <45 years (+7.3%; 95% CI +3.6% to +11.0%), for physicians in the highest tertile of antibiotic prescribing volume (+4.9%; 95% CI +3.0% to +6.8%), during telehealth visits (+3.9% vs office visits; 95% CI +0.02% to +7.7%) and during regular hours care versus after hours care (+2.1%; 95% CI +0.7% to +3.5%). These findings were qualitatively unchanged when including both solo and group practice clinics.Conclusions Targeting younger patients, patients with comorbidities, older physicians, physicians with high antibiotic prescribing, telehealth visits and regular hours care may further increase stewardship effectiveness.",
  "authors": [
    {
      "affiliations": [
        "Public Health Research Group, Institute of Medicine, University of Tsukuba, Tsukuba, Japan",
        "Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan",
        "Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan"
      ],
      "name": "Atsushi Miyawaki"
    },
    {
      "affiliations": [
        "Division of Infectious Diseases, Department of Medicine, Penn Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA",
        "Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Joseph B Ladines-Lim"
    },
    {
      "affiliations": [
        "M3 Inc, Minato-ku, Japan"
      ],
      "name": "Daichi Sato"
    },
    {
      "affiliations": [
        "M3 Inc, Minato-ku, Japan"
      ],
      "name": "Kei Kitajima"
    },
    {
      "affiliations": [
        "Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA"
      ],
      "name": "Jeffrey A Linder"
    },
    {
      "affiliations": [
        "Section of General Internal Medicine, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA"
      ],
      "name": "Michael A Fischer"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA",
        "Susan B. Meister Child Health and Evaluation Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA"
      ],
      "name": "Kao-Ping Chua"
    },
    {
      "affiliations": [
        "Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California, USA",
        "Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA"
      ],
      "name": "Yusuke Tsugawa"
    }
  ],
  "title": "Association of patient, physician and visit characteristics with inappropriate antibiotic prescribing in Japanese primary care: a cross-sectional study",
  "uid": "88d18ece-63a2-554e-9232-d882dbefd837"
}