Evaluation of a Rule-Based Program to Describe Antibiotic Utilization for Otitis Media Among Three Medical Plans

Abstract

OBJECTIVE: The purpose of this study was to develop and test an analytical technique for describing variations in the antibiotic prescribing process for otitis media (OM) in ambulatory medical plans. DESIGN: Using medical, hospital, and pharmacy claims over an 18-month period, a computerized rule-based system identified which antibiotics were probable therapies for OM. For each patient and OM episode of treatment, the rule based system recorded the ordinal sequencing of specific antibiotics, including first-line and follow-up choices, to treat the OM condition. SETTING: Three medical plans in the Midwest were studied: a Medicaid-funded IPA-model HMO; an employer-funded, indemnity-based PPO; and an employer-funded "at-risk" network. RESULTS: The number of OM antibiotics dispensed per subject was similar among plans. For first-line therapy, inexpensive penicillinase-sensitive penicillins, trimethoprim-sulfamethoxazole, and erythromycin-sulfisoxazole, combined, accounted for 74.6%, 47.2%, and 47.7% of total ...