Newsroom | Collaborative Care

With every stroke of a pen on the prescription pad, doctors aim to make a positive difference in a patient’s life.  

But when it comes to antibiotic prescribing, they could also unwittingly be part of a growing problem — the slow march toward a world where antibiotics no longer kill the bacteria they were designed to destroy.  

Antibiotic resistance
Antibiotics have been used to treat infections since penicillin was discovered in 1928. But not every antibiotic is guaranteed to work forever, because bacteria change and learn to fight off antibiotics over time, too.   

“The bugs, organisms, are getting smarter,” says Lorene Campbell, a nurse and infection preventionist with the Association for Professionals in Infection Control and Epidemiology. “They’ve been around and seen (penicillin) and they’ve outsmarted it.”  

The overuse of antibiotics, either in the form of prescribing too strong of an antibiotic for certain infections or prescribing and antibiotic when it isn’t needed, such as a viral infection or common cold, can lead to resistant bacteria. Public health experts estimate that 30% of antibiotics prescribed in an outpatient setting are unnecessary.  

This microscopic battle has other cost and quality of life consequences as well. About 2 million Americans get an antibiotic-resistant infection each year. And it costs an added $1,383 per patient when an infection is resistant to drugs — meaning antibiotic resistance costs the U.S. $2.2 billion each year. Treating such resistant infections, when they can be treated, also typically means patients may have more complicated and longer treatments, that may also have more side-effects.   

Reduce unnecessary use  
Everyone involved in the health care system — from hospitals and clinicians to patients and even payers — has a role to play in reducing the use of unnecessary antibiotics.  

Most hospitals have antibiotic stewardship programs, which means considering antibiotics a valuable resource using them wisely, not wastefully. Clinicians are also policing their prescribing practices and educating patients when antibiotics are and are not helpful. For their part, patients can try to stop pressuring doctors for a prescription.  

Insurers like Blue Cross and Blue Shield of Montana (BCBSMT) have stepped in to do their part as well. BCBSMT harnessed its data to start an antibiotic stewardship program in late 2017.  

Using pharmacy claims data, BCBSMT identified providers who may be over-prescribing antibiotics.  

BCBSMT reached out to each of these doctors, nurse practitioners and physician assistants to make them aware that they prescribe more antibiotics than peers in their specialty and encouraged them to follow CDC-recommended antibiotic stewardship best practices.  

Hala Ibrahim, director of enterprise quality reporting for the Blue Cross and Blue Shield Plans in Illinois, Montana, New Mexico, Oklahoma and Texas, says focusing on individual clinicians can lead to widespread change. “When a provider changes behavior, it impacts everyone.”  

And the program has paid off. BCBSMT noted a 25% improvement.    

Success and the future 
Thanks to stewardship programs like BCBSMT’s, use of antibiotics has dropped in recent years. A Health of America  report from the Blue Cross Blue Shield Association showed a 9% decline in filled antibiotic prescriptions from 2010 to 2016. Even more encouraging, fill rates for broad-spectrum antibiotics fell 13% in that timeframe.  

But there’s still work to be done. Unnecessary antibiotic prescriptions are still high, especially in places like urgent care centers and walk-in clinics. These places play a major role in prescribing antibiotics for common respiratory conditions for which antibiotics aren’t recommended are aren’t effective.  

If everyone involved in health care continues to work together on the problem, the progress shown in the Blue Cross Blue Shield report will likely continue.  

“Anytime we can all work together as a health care system — patient, clinician, insurer, infection prevention — if we work together to do what’s better for the patient, we optimize health care as a whole,” Campbell says.