• Courtney Hebert, Jennifer Beaumont, Gene Schwartz, and Ari Robicsek.
• The Ohio State University Wexner Medical Center, Department of Biomedical Informatics, 3190 Graves Hall, 333 West Tenth Avenue, Columbus, OH 43210, USA. courtney.hebert@osumc.edu
• Ann. Intern. Med. 2012 Aug 7;157(3):160-9.

BackgroundLittle is known about the influence of contextual factors on a physician's likelihood to prescribe antimicrobials for febrile respiratory illness (FRI). Context includes epidemiologic context (for example, a pandemic period) and personal context (for example, recent exposure to other patients with FRI).ObjectiveTo examine the association between contextual factors and antimicrobial prescribing for FRI.Design5.5-year retrospective cohort study.SettingA network of Midwestern primary care providers.PatientsAll patients presenting with FRI during influenza seasons between 2006 and 2011.MeasurementsAntimicrobial prescribing for FRI during pandemic and seasonal influenza periods.Results28 301 unique patient encounters for FRI with 69 physicians in 26 practices were included. An antibiotic was prescribed in 12 795 (45.2%) cases. The range of prescribing among physicians was 17.9% to 83.7%. Antibiotics were prescribed in 47.5% of encounters during the seasonal period and 39.2% during the pandemic period (P < 0.001). After multivariable adjustment for patient and physician characteristics, antibiotic prescribing was lower in the pandemic period (odds ratio [OR], 0.72 [95% CI, 0.68 to 0.77]) than in the seasonal period. The likelihood of prescribing an antibiotic decreased as the number of FRI cases that a physician had seen in the previous week increased (OR, 0.93 [CI, 0.86 to 1.01] for 2 to 3 patients with FRI seen in the previous week; OR, 0.84 [CI, 0.77 to 0.91] for 4 to 6 patients; OR, 0.71 [CI, 0.64 to 0.78] for 7 to 11 patients; and OR, 0.57 [CI, 0.51 to 0.63] for ≥12 patients compared with the reference range of 0 to 1 patients). Pandemic season and recent personal context were also associated with antiviral prescribing.LimitationRetrospective study in a single geographic area.ConclusionEpidemiologic context and the number of cases of FRI that a physician had recently seen were associated with his or her likelihood to prescribe antimicrobials for FRI. Interventions that enhance a physician's contextual awareness may improve antimicrobial use.Primary Funding SourceNorthShore University HealthSystem.

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