A study using data from the NIH Collaboratory’s Distributed Research Network (DRN) has found uneven declines in potentially inappropriate antibiotic dispensing between 2006 and 2016. Researchers say the findings suggest a need for antibiotic stewardship programs, especially interventions focusing on the use of broad-spectrum antibiotics in outpatient settings.
The study, published recently in Pharmacology Research & Perspectives, used national claims data for more than 73 million pediatric visits. Although overall antibiotic prescribing among children in outpatient settings has declined since the mid-1990s, recent evidence suggests the trend may be ending. Also, it is unknown whether antibiotic stewardship efforts have influenced prescribing trends in emergency department settings.
In the new study, which included children and adolescents aged 3 months to 18 years, there was a 5 percent annual decrease in antibiotic prescribing in emergency departments for respiratory tract infections for which antibiotics are mostly not or never indicated. The annual decline in outpatient settings was 2 percent. For broad-spectrum antibiotics for respiratory tract infections for which antibiotics are mostly indicated, there were annual declines of 2 percent to 4 percent in emergency department settings, compared with an annual increase of 1 percent in outpatient settings. Dispensing rates were consistently higher among children younger than 12 years than among adolescents.
Three DRN data partners provided summarized population level data for this study. The HealthCore Integrated Research Environment (HIRE) provided access to data from 65 million commercially insured members in primarily 14 different states, of whom 25 percent were children. The Aetna research database provided access to data from 40 million commercially insured members, of whom 25 percent were children. The Harvard Pilgrim HealthCare Institute provided access to data from 3.7 million members of nonprofit health plans, of whom 28 percent were children.
The research was supported by a grant from the National Center for Complementary and Integrative Health. Support was also provided within the NIH Collaboratory by the NIH Common Fund through a cooperative agreement from the Office of Strategic Coordination within the Office of the NIH Director.
The NIH Collaboratory Distributed Research Network lets investigators collaborate with each other in the use of electronic health data, while also safeguarding protected health information and proprietary data. It supports both single- and multisite research programs.
The network’s querying capabilities reduce the need to share confidential or proprietary data by enabling authorized researchers to send queries to collaborators holding data. This form of remote querying reduces legal, regulatory, privacy, proprietary, and technical barriers associated with data sharing for research. By facilitating knowledge exchange without requiring a massive data warehousing effort, the DRN combines local control and security with the power that can be achieved from large datasets.
The DRN uses the PopMedNet software application and complies with the standards for distributed querying supported by the Office of the National Coordinator for Health Information Technology’s Query Health Initiative and adopted by other research collaborations, including Mini-Sentinel.
