Non-Teaching VA Clinics More Likely to Prescribe Inappropriate Antibiotics

PROVIDENCE, RI – The VA is working hard to stem the rate of unnecessary and inappropriate antibiotic prescribing in its healthcare system. A new study identifies an area where more work might be required.

Researchers with the Providence, RI, VAMC report that the rate of inappropriate prescribing for acute respiratory infections — sinusitis, pharyngitis, bronchitis, and pneumonia — in the hospital’s outpatient primary care department was 38.4%.1

That rate can be compared to 34.2% for similar non-federal facilities in a May 2016 study by the national Centers for Disease Control and Prevention (CDC), according to the research letter in Antimicrobial Resistance and Infection Control. The CDC study did not include VA or other federal facilities.

In the study conducted in veterans from March 2013 through February 2015, overall prescribing rates and inappropriate prescribing rates were evaluated. Results indicated that inappropriate prescribing was similar to non-government healthcare facilities, as well as other VA facilities.

The study also revealed, however, that teaching clinics had both a significantly lower rate of overall antibiotic prescribing for acute respiratory conditions than the non-teaching clinics– 37% vs. 65.9% — and a much lower rate of inappropriate prescribing –17.6% vs. 44%.

The likelihood of receiving an inappropriate antibiotic for a respiratory condition was far greater in the VA’s non-teaching clinics; the report noted that only 3.8% of pharyngitis patients at teaching clinics were prescribed antibiotics compared to 40.3% at non-teaching clinics.

The article added that the Providence VAMC began antibiotic stewardship program (ASP) in 2012, based on a prospective audit and feedback strategy. The program has helped reduce broad-spectrum antibiotic use, length of stay, and adverse events, according to study authors who suggest that non-teaching outpatient clinics could be a target for expanding the program.

“Our findings are unique in suggesting that outpatient ASPs may benefit from focusing their efforts in non-teaching clinics, at least among VA clinics,” the authors wrote. 

All data as no. (%)
VA veterans affairs
aFleming-Dutra et al. inappropriate prescribing definitions
bUnweighted sample data among age ≥20

  1. Parente DM, Timbrook TT, Caffrey AR, LaPlante KL. Inappropriate prescribing in outpatient healthcare: an evaluation of respiratory infection visits among veterans in teaching versus non-teaching primary care clinics. Antimicrob Resist Infect Control. 2017 Mar 29;6:33. doi: 10.1186/s13756-017-0190-3. eCollection PubMed PMID: 28360995; PubMed Central PMCID: PMC5371270.

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