Validating a popular outpatient antibiotic database to reliably identify high prescribing physicians for patients 65 years of age and older

Autoři: Kevin L. Schwartz aff001;  Cynthia Chen aff002;  Bradley J. Langford aff001;  Kevin A. Brown aff001;  Nick Daneman aff001;  Jennie Johnstone aff001;  Julie HC Wu aff001;  Valerie Leung aff001;  Gary Garber aff001
Působiště autorů: Public Health Ontario, Toronto, Ontario, Canada aff001;  ICES, Toronto, Ontario, Canada aff002;  Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada aff003;  Unity Health Toronto, Toronto, Ontario, Canada aff004;  Sunnybrook Research Institute, Division of Infectious Diseases, Toronto, Ontario, Canada aff005;  The Institute of Health Policy, Management, and Evaluation, University of Toronto, Ontario, Canada aff006;  Sinai Health System, Toronto, Ontario, Canada aff007;  Ottawa Research Institute, Ottawa, Ontario, Canada aff008
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223097



Many jurisdictions lack comprehensive population-based antibiotic use data and rely on third party companies, most commonly IQVIA. Our objective was to validate the accuracy of the IQVIA Xponent antibiotic database in identifying high prescribing physicians compared to the reference standard of a highly accurate population-wide database of outpatient antimicrobial dispensing for patients ≥65 years.


We conducted this study between 1 March 2016 and 28 February 2017 in Ontario, Canada. We evaluated the agreement and correlation between the databases using kappa statistics and Bland-Altman plots. We also assessed performance characteristics for Xponent to accurately identify high prescribing physicians with sensitivity, specificity, positive predictive value (PPV), and negative predictive value.


We included 9,272 physicians. The Xponent database has a specificity of 92.4% (95%CI 92.0%-92.8%) and PPV of 77.2% (95%CI 76.0%-78.4%) for correctly identifying the top 25th percentile of physicians by antibiotic volume. In the sensitivity analysis, 94% of the top 25th percentile physicians in Xponent were within the top 40th percentile in the reference database. The mean number of antibiotic prescriptions per physician were similar with a relative difference of -0.4% and 2.7% for female and male patients, respectively. The error was greater in rural areas with a relative difference of -8.4% and -5.6% per physician for female and male patients, respectively. The weighted kappa for quartile agreement was 0.68 (95%CI 0.67–0.69).


We validated the IQVIA Xponent antibiotic database to identify high prescribing physicians for patients ≥65 years, and identified some important limitations. Collecting accurate population-based antibiotic use data will remain vital to global antimicrobial stewardship efforts.

Klíčová slova:

Antibiotics – Antimicrobials – Outpatients – Physicians – Primary care – Rural areas – Ontario – Canada


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