Researchers at Brigham and Women's Hospital in Boston have discovered that physicians prescribe more antibiotics, often unnecessarily, later in a typical day than earlier.

The researchers merged billing and electronic health record data for patient visits to 23 different primary care practices over the course of 17 months. They then identified visit diagnoses using billing codes and, using EHRs, identified visit times, antibiotic prescriptions and chronic illnesses.

Researchers analyzed more than 21,000 visits by adults complaining of acute respiratory infections, which occurred during two four-hour sessions, 8 a.m. to noon and 1 p.m. to 5 p.m. They found that antibiotic prescribing increased throughout the morning and afternoon clinic sessions.

“This corresponds to about 5 percent more patients receiving antibiotics at the end of a clinic session compared to the beginning, “explained lead author Jeffrey Linder, M.D. “Remedies for this problem might include different schedules, shorter sessions, more breaks or maybe even snacks.”

The researchers noted that future studies are needed to clarify the sources of the problem and test corresponding solutions.

The study, published online in JAMA Internal Medicine, is available here.

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