(C-079) Antibiotic Prescribing Trends by Provider Specialty and Drug Class Before and During the COVID-19 Pandemic (2013-2022)

Background: The COVID-19 pandemic put a burden on the healthcare system and affected many aspects, like antibiotic prescribing. Antibiotic prescribing is one aspect that should be subject to scrutiny, especially within the older population who have an increased risk of infection and higher rates of antibiotic use compared to the general population.

Objectives: This study aims to analyze antibiotic prescribing trends within Medicare Part D beneficiaries by provider specialty and drug class from 2013-2022.

Methods: The study is a cross-sectional, descriptive study in which Medicare Part D Public Use Files (PUFs) are used and analyzed; provided by the Centers for Medicare and Medicaid (CMS). These PUFs contain prescriber information based on region, drug, and specialty from 2013-2022. The data set was then analyzed by SAS and R which analyzed and visualized variables like provider specialty percentage and frequency of antibiotic drug and class. These variables were represented in figures to highlight overall trends and segmented regression within a time series framework for the context of COVID-19 and relevant antibiotic prescribing guidelines.

Results: The antibiotic claims per 1,000 Medicare beneficiaries stayed consistently above 1,000, decreasing slightly until 2020 when it dropped to 850 and stayed consistent, increasing to 930 during 2022. The most frequently used antibiotic classes were penicillins, cephalosporins, and macrolides. Among specialties, dentistry (20%), nurse practitioner (15%), family practice (12%), internal medicine (11%), and physician’s assistant (10%) form the top 65% of prescribers. Mid-level practitioners (nurse practitioners, physician’s assistants) have had an increasing prevalence among prescribers and are the top prescribers since 2018, which was previously dentistry.

Conclusions: The continual decrease in claims per beneficiary from 2013-2019 might indicate stronger adherence to prescribing guidelines, however, decreased claims during the years 2020 and 2021 indicate a significant impact from the COVID-19 pandemic, likely from reduced visits to health care systems, greater attention to sanitary efforts, and drug shortages. Antibiotic class data, before and during the pandemic, shows which drugs have been overprescribed in response to infectious disease concerns. Providers also have a key role in preventing the overprescription of antibiotics, especially among the older generations. This study will help inform future research on the lingering effects of the COVID-19 pandemic and provide insight for future prescribing guidelines among Medicare beneficiaries.