# Identifying and analyzing high-prescribers of opioids and antibiotics using medicare part D data

## TL;DR

This study identifies primary care providers in New York State who prescribe large amounts of opioids and antibiotics, finding that certain provider types and practice characteristics are linked to high prescribing.

## Contribution

The study provides new insights into provider-level factors associated with high opioid and antibiotic prescribing using Medicare Part D data.

## Key findings

- Nurse practitioners and physician assistants were more likely to be high antibiotic prescribers.
- Geriatric providers and male clinicians were more likely to be high opioid prescribers.
- Longer years in practice and higher beneficiary risk scores were linked to higher prescribing rates.

## Abstract

Excess prescribing of antibiotics and opioids is a major public health concern. A greater understanding of prescribing patterns at the prescriber and beneficiary level could inform enhanced and integrated interventions.

Using 2023 Medicare Part D Public Use data, we conducted a cross-sectional study to assess opioid and antibiotic prescribing patterns among primary care clinicians (internal medicine, family medicine, geriatrics, nurse practitioners, and physician assistants) in New York State (NYS) treating ≥20 Medicare beneficiaries aged ≥65. For each provider, the total days’ supply of antibiotics and opioids per beneficiary was calculated. Multivariate logistic regression models identified provider and practice characteristics associated with high-prescribing.

Of the 19,823 eligible prescribers, 647 (3.3%) were high antibiotic prescribers and 554 (2.8%) were high opioid prescribers. Antibiotic high-prescribing was associated with nurse practitioners (NP) (adjusted odds ratio (aOR 2.47, 95% CI 1.83–3.34)), physician assistants (PA) (aOR 1.90, 95% CI 1.43–2.54), more years in practice (aOR 1.62 per SD, 95% CI 1.47–1.78), and panels with higher average beneficiary risk scores (aOR 1.36 per SD, 95% CI 1.29–1.43). Opioid high-prescribing was associated with geriatrics (aOR 4.30, 95% CI 1.79–10.32), NP (aOR 1.80, 95% CI 1.36–2.37), male gender (aOR 1.55, 95% CI 1.17–2.04).), greater years in practice (aOR 1.68, 95% CI 1.51–1.86), and higher proportions of dual-eligible beneficiaries (aOR 1.38, 95% CI 1.23–1.56).

A small number of NYS clinicians account for a disproportionate share of antibiotic and opioid prescribing. Identifying provider- and panel-level characteristics associated with higher prescribing may inform targeted stewardship strategies.