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Two new studies authored by University of Michigan physicians and their colleagues have highlighted the issue of inappropriate antibiotic prescribing due to lack of detailed record-keeping in clinics and emergency departments. The studies reveal that a significant number of patients who received antibiotic prescriptions did not have a specific reason documented in their records. This trend was more prevalent in adults seen in emergency departments and clinics with Medicaid coverage or no insurance, but also occurred in children. Without proper documentation, it becomes challenging for healthcare organizations to address inappropriate antibiotic use and ensure that antibiotics are prescribed only when necessary to prevent antibiotic resistance.

Overuse and misuse of antibiotics can lead to antibiotic resistance, making these medications less effective for everyone. Not having the information about the reason for inappropriate antibiotic prescriptions hinders efforts to reduce such prescribing practices. The studies co-authored by Joseph Ladines-Lim and Kao-Ping Chua suggest that inadequate record-keeping makes it difficult to estimate the true extent of inappropriate antibiotic prescriptions and focus on strategies to curb them. This lack of clear documentation may result in patients receiving antibiotics that do more harm than good.

The new studies build upon previous research by Chua and colleagues, which estimated that 25% of outpatient antibiotic prescriptions may be inappropriate. However, the current studies delve deeper into the different types of inappropriate prescriptions, distinguishing between antibiotics prescribed for conditions that do not benefit from antibiotics, such as colds, and prescriptions with no infection-related diagnoses or symptoms recorded. While most antibiotic stewardship programs focus on reducing the first type of inappropriate prescription, identifying patients with undiagnosed secondary bacterial infections is more challenging as symptoms may provide insight into the necessity of antibiotics.

Factors contributing to inadequate record-keeping for prescriptions without specific diagnoses include inadvertent negligence by clinicians, deliberate actions to avoid scrutiny, and differences in reimbursement structures for patients with Medicaid or no insurance. Healthcare organizations may not have the same incentives to maintain detailed records for these patients compared to those with private insurance. Addressing this issue of health equity in antibiotic prescribing may require incentivizing accurate coding for antibiotic prescriptions and improving documentation practices. Mandating providers to record the reason for antibiotic prescriptions before sending them to pharmacies through electronic health record systems could help ensure accountability and proper justification for antibiotic use.

Given the global threat of antibiotic resistance, steps need to be taken to justify the appropriate use of antibiotics. Physicians currently justify ordering tests like CT scans or x-rays with specific diagnoses, and a similar approach may be necessary for prescribing antibiotics. Incentivizing accurate documentation and diagnosis coding for antibiotic prescriptions by private and public insurers, as well as health systems, could help address the issue of inappropriate antibiotic use. The studies were funded by various grants and awards, providing valuable insights into the need for improved record-keeping in healthcare settings and the implications for antibiotic stewardship.

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