Patterns in outpatient antibiotic prescribing in Switzerland: a five-year analysis of claims data from 2019 to 2023
Philipp Stefan Aebi, Lena Zwicker, Melinda Toth, Caroline Bähler, Christian Frei, Maria Trottmann, Reto Auer, Adrian RohrbasserAbstract
Objective:
Antimicrobial resistance threatens the effectiveness of future therapies. Interventions to reduce the rate of unnecessary antibiotics prescription in the Swiss outpatient setting typically target primary care physicians (PCPs). However, patients might receive antibiotics from other healthcare providers. We set out to provide a descriptive analysis of total antibiotic prescribing and the providers who prescribed them among patients in such a plan.
Methods:
We performed a retrospective repeated yearly cross-sectional study from 2019 to 2023 in claims data from one insurer in Switzerland (SWICA insurance). We restricted the sample to patients registered in a managed-care plan with PCP serving as a gatekeeper in the SWICA database. We provide descriptive statistics of total antibiotic prescription fills, the proportion of antibiotics prescribed by the gatekeeping PCP vs other healthcare providers and the type of antibiotic prescribed.
Results:
The population comprised 106,307 patients in 2019 and 113,343 in 2023. The gatekeeping PCP accounted for 40% of antibiotic prescription in 2019, and 36% in 2023. In 2023, other group practices, other PCPs and hospital outpatient departments together accounted for 40% of prescription fills. Gatekeeping PCPs issued a higher proportion of Watch antibiotics than other providers in both 2019 (35% vs 25%) and 2023 (30% vs 21%).
Conclusion:
In a restricted sample of patients affiliated in a healthcare plan where PCP serve as gatekeepers in one insurance in Switzerland, most outpatient antibiotics were not prescribed by the primary gatekeeping PCP. Future antibiotic stewardship interventions in outpatients should consider further prescribers in the network.