BY THE NUMBERS
Annual 2009 antibiotic use for seniors with Medicare Part D:
Alabama: 55.6 percent
Georgia: 51.5 percent
Tennessee: 54.5 percent
Source: Yuting Zhang: "Geographic Variation in Outpatient Antibiotic Prescribing Among Older Adults"
The phone call is a common one for Chattanooga doctors - a patient is coughing, feverish or just under the weather. She wants something to make her better.
She wants an antibiotic.
"It really is an issue. Everybody wants a quick fix when they get sick," said Dr. Henry Williams, who regularly must convince patients that antibiotics aren't the correct prescription for viral infections.
A recent study shows that more than half of seniors using Medicare Part D prescription drug coverage in Tennessee, Georgia and Alabama were prescribed antibiotics as outpatients in 2009, some of the highest figures in the nation. Maine had the lowest prescription rate, at 39.5 percent for seniors using Part D, and Mississippi had the highest at 56.8 percent.
The study, which looked at geographic variation in outpatient antibiotic prescribing, found doctors in the South prescribe the most antibiotics and those in the West the fewest. The study used national Medicare Part D data from 2007 through 2009 among people age 65 and older, adjusting for regional differences.
While this study looked specifically at older patients, previous studies of commercial health plans for younger patients found similar results -- the South had the highest use of antibiotics.
"Overuse of antibiotics is common and the consequences of overuse are substantial," Yuting Zhang, lead author of the study published in the Archives of Internal Medicine, said in a news release. "Not only can it lead to unnecessary spending for prescription drugs, it can also increase antimicrobial resistance."
The study found a correlation between numbers of antibiotic prescriptions and spending on the drugs in most states. Tennessee, Georgia and Alabama all spent from $38 to $47 per beneficiary for antibiotic prescriptions, while some states spent only $20 to $27.
The time of year also influenced antibiotic usage - highest in January to March and lowest for July through September.
However, the regional variations did not seem to be explained by regional differences in major infections, the study noted. The South had the highest number of nonspecific upper respiratory infections, but antibiotics are not generally recommended because many such infections are viral, the study noted.
"Many programs have aimed to reduce inappropriate antibiotic use ... but ample room exists for additional reductions, especially in the overuse of antibiotics for acute respiratory tract infections and other unnecessary indications," the study noted.
"A lot of convincing"
Williams, a doctor at Chattanooga Internal Medicine Group and part of Memorial Health Partners, said he generally tries not to prescribe antibiotics over the phone. He explains to patients that antibiotics can cause harm and won't cure a virus.
Side effects, particularly for elderly patients, can be worse than the initial infection, he said. Not only do patients build up resistance to antibiotics - which means the drugs won't work as effectively, if at all -- overprescribing can cause life-threatening intestinal infections.
Elderly patients also often have prescriptions for other medications, which increase the risk of reactions.
"The hard part is getting people on the same page," said Williams. "You want to keep them happy, but you have to balance that with keeping them safe."
More patient education and awareness are needed, he said. Most doctors are aware of the dangers but might give in to a patient's pleading.
Dr. Akberet Hadgu, with the Diagnostic Center at Parkridge Medical Group, said she has had several discussions with colleagues about dealing with patients who want antibiotics prescribed over the phone. Allergies and viruses are common in the Chattanooga area, and most patients are sure an antibiotic will help them, she noted.
"Sometimes it takes a lot of convincing," Hadgu said. "Patients need to be educated about the dangers."