28 Mar 2022 What is your first-line choice for uncomplicated UTI?
An individual Portrait on prescribing for uncomplicated urinary tract infections (UTI) was sent to approximately 5070 family doctors in BC, randomized to receive the Portrait in two groups. The Portraits were mailed to the early group in September 2021 and to the delayed group in March 2022. This Portrait was produced by the Therapeutics Initiative, in collaboration with the BC Centre for Disease Control (BCCDC).
This Portrait was accompanied by Therapeutics Letter #135: Empiric Antibiotic Therapy for Uncomplicated Lower Urinary Tract Infections.
Below is a sample Portrait containing fictional individual physician data. To view this sample Portrait in PDF format, click on the DOWNLOAD button above.
BC: British Columbia
BCCDC: British Columbia Centre for Disease Control
E. coli: Escherichia coli
EMR: electronic medical record
FP: family practitioner
GP: general practice
ICD: International Classification of Diseases
MSP: Medical Services Plan
PSP: Practice Support Program
RCMP: Royal Canadian Mounted Police
UTI: urinary tract infection
- Therapeutics Initiative. Empiric antibiotic therapy for uncomplicated UTI. Therapeutics Letter. 2022 (Jan-Feb);135:1-2.
Who received this portrait?
BC physicians meeting all of the following criteria received an individual Portrait:
- general practice (GP) physicians, including family practitioners (FP), who were registered by the BC Medical Services Plan (MSP) as an active practice, or physicians registered primarily as GP-emergency medicine and FP-emergency medicine physicians; and
- had a valid mailing address in BC according to the College of Physicians and Surgeons of British Columbia’s public physician information; and
- had ≥100 prescriptions filled at a community pharmacy in 2020 according to PharmaNet claims data, and
- prescribed an oral antibiotic as first-line treatment to at least one eligible UTI patient in 2019-2020 according to PharmaNet claims data; and
- did not opt out of the Portrait program.
How are patients assigned to this Portrait?
Patients were included in a physician’s Portrait if they met all of the following criteria:
- were registered with the MSP at any time in 2019-2020; and
- had an uncomplicated UTI based on:
- female (based on PharmaNet information); and
- had a visit with a diagnosis of UTI recorded in MSP claims between December 27, 2018 and December 31, 2020, defined as International Classification of Diseases (ICD)-9 diagnosis codes: cystitis (595, 595.0, 595.3-595.9), UTI site not specified (599, 599.0, 599.8, 599.9), symptoms involving urinary system or dysuria (788, 788.9, 788.1), other disorders of bladder (596.X), hematuria (599.7), or nonspecific findings on examination of urine (791.X), where X stands for any characters; and
- were age ≥15 years at time of dispensation; and
- filled an oral antibiotic with that physician’s prescribing number in PharmaNet within 5 days of the physician visit and between January 1, 2019 and December 31, 2020.
Women were excluded from a physician’s Portrait if they met any of the following criteria for complicated UTI or incomplete data. Diagnosis criteria were determined based on available MSP and hospital discharge data, and the list of diagnosis codes is presented in the table below. All dates were calculated from date of physician visit when UTI was diagnosed. Women were excluded if they:
- were pregnant, defined as female with a pregnancy diagnosis code before UTI visit and without a delivery/pregnancy outcome code before UTI visit; or
- had recurrent UTI, defined as an MSP record of physician visit with a diagnosis of UTI before the UTI visit; or
- were discharged from hospital in the previous 30 days before the UTI visit; or
- were diagnosed with kidney disease or infection (pyelonephritis); or
- were diagnosed with chronic kidney disease; or
- had indwelling catheter; or
- were diagnosed with impaired renal function; or
- had structural or functional abnormality of the urinary tract, defined as stones, ureteral abnormalities/ vesicoureteral reflux, neurogenic bladder, or neurologic condition; or
- were diagnosed with a sexually transmitted infection (STI) before or after UTI visit; or
- had systemic (oral, intravenous, or injection) antibiotic use in the prior 3 months, as recorded in PharmaNet: amoxicillin, cefalexin, nitrofurantoin, amoxicillin and beta-lactamase inhibitor, doxycycline, azithromycin, ciprofloxacin, sulfamethoxazole and trimethoprim, clindamycin, clarithromycin, cefixime, phenoxymethylpenicillin, fosfomycin, moxifloxacin, minocycline, cefuroxime, tetracycline, cloxacillin, erythromycin, cefadroxil, levofloxacin, ceftriaxone, trimethoprim, ertapenem, daptomycin, vancomycin, cefazolin, meropenem, piperacillin and beta-lactamase inhibitor, ampicillin, cefprozil, linezolid, ceftazidime, norfloxacin, tobramycin, gentamicin, benzylpenicillin, colistin, amikacin, metronidazole, cefoxitin, imipenem and cilastatin, tigecycline, ceftolozane and beta-lactamase inhibitor, cefepime, ceftobiprole medocaril, spiramycin, cefotaxime, benzathine phenoxymethylpenicillin, fusidic acid, or methenamine, or
- were on PharmaCare plan P (palliative) or plan B (long-term care) on date of dispensation or within 3 months; or
- were registered with MSP for <77 of the previous 91 days.
|Disease/condition||Identification period relative to the UTI visit||MSP: ICD-9 codes||Hospital/ICD-10 codes||MSP: Fee items|
|Pregnancy||Prior 270 days||14090, 14091, 36360, 36361, or 04717|
|Pregnancy outcome (delivery, abortion)||Prior 270 days and after pregnancy code||630.X, 631.X, 632.X, 633.X, 634.X, 635.X, 636.X, 637.X, V24.X, V27.X, 656.4||O02.X, O03.X, O04.X, O05.X, Z37.X, O36.4X|
|Recurrent UTI||Prior 90 days (1+ visit) / prior 3 years (4+ visits)||595, 595.0, 595.3-595.9, 599, 599.0, 599.8, 599.9, 788, 788.9, 788.1, 596.X, 599.1, 791.X|
|Kidney disease or infection (pyelonephritis)||Prior or following 10 days||590, 590.1, 590.2, 590.8, 590.9||10 N10, N12, N15.1, N.16|
|Chronic kidney disease||Prior 365 days||585.X||N18.X||MSP complex care CKD codes N585, R585, I585, H585, D585, C585, K573|
|Indwelling catheter||Prior 91 days||V53.6, 996.64, 996.76, 996.31||T83.0X, Z46.6, Z96.0|
|Impaired renal function||Prior 365 days||33758, 33723, 33759, 33761, or seen by a nephrologist|
|Structural or functional abnormality of the urinary tract||Prior 365 days||592.X, 594.X, 593.X, 753.1, 596.4, 596.5, 344.6, 323.X, 323.X, 336.X, 337.X, 340.X, 341.X, 343.X, 344.X, 952.X||N20.X, N21.X, N13.X, N28.83, Q61.X, G83.4, N31.X, N32.81, N36.44, G05.4, G23.0, G35.X, G36.X, G37.X, G80.0-G80.2, G81, G82.5, G90.4, G95.0, S14.101-S14.104|
|STI||Prior or following 14 days||091-094, 096-099, 099.0-099.4, 099.8, 099.9, 078||A51-A60, A63, A64, A74.8, A74.9|
What prescriptions were counted in this Portrait?
Oral antibiotic prescription records are extracted from PharmaNet claims data and include all prescriptions filled at a community pharmacy in BC with that physician’s prescribing number.
The following prescription data were not included:
- prescription data for patients who are federally insured (e.g. Veterans, RCMP, Armed Forces and beneficiaries of Non-Insured Health Benefits); and
- prescription data for patients insured by the First Nations Health Authority (Plan W); and
- reversed prescription claims; and
- out-of-province prescriptions; and
- medication dispensed in a hospital or a correctional centre.
All oral formulation prescription antibiotics available in BC were included: amoxicillin, cefalexin, nitrofurantoin, amoxicillin and beta-lactamase inhibitor, doxycycline, azithromycin, ciprofloxacin, sulfamethoxazole and trimethoprim, clindamycin, clarithromycin, cefixime, phenoxymethylpenicillin, fosfomycin, moxifloxacin, minocycline, cefuroxime, tetracycline, cloxacillin, erythromycin, cefadroxil, levofloxacin, trimethoprim, ampicillin, cefprozil, linezolid, norfloxacin, metronidazole, spiramycin, vancomycin, benzathine phenoxymethylpenicillin, fusidic acid, and methenamine.
The research objective is to determine the impact of the Portrait on physician prescribing of antibiotics for uncomplicated UTI. This impact is evaluated at an aggregated level by comparing pooled prescribing data from physicians in the early mailing group to pooled prescribing data from physicians in the delayed group. All prescribing data analyzed for this evaluation do not contain names, only encrypted patient and physician numbers. No physician or patient will be identified in any reports or publications. Portrait’s data access agreement requires the masking of data elements when <6 individuals (patients or physicians) are included. Ethics approval for this evaluation will be obtained from the University of British Columbia Ethics Review Board.
If you have any questions or would like further information with respect to this evaluation, you may contact the Portrait team at (604) 822-4887 or email email@example.com
Can I request the names of my patients included in this Portrait?
No. Portrait’s data access agreement only permits access to encrypted patient identifiers. There is no way for us to identify individual patients in the data or to provide you with a list.
However, other resources may be available for you. Contact your Practice Support Program (PSP) regional team to discuss how they might help you use your EMR to identify these patients.
Why does my Portrait show ranges of patients that I treated (1-20, 20-30, etc.), and not exact numbers?
Portrait’s data access agreement requires the masking of data elements when <6 individuals (patients or physicians) are included. As prescriptions are presented as percentages, we grouped the number of patients in order to mask low numbers of patients in each daily dose category.