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门诊无明确指征的抗生素处方的调查研究
作者:小柯机器人 发布时间:2019/12/17 16:46:14

美国波特兰州立大学公共卫生学院Michael J Ray小组对门诊就诊中无明确指征的抗生素处方进行了一项全国横断面研究。该项研究成果2019年12月11日在线发表在《英国医学杂志》上。

为了研究门诊医疗中,在没有记录适应症的情况下使用抗生素的频率,研究组在2015年进行了一次全国门诊医疗调查,在这项横断面研究中,从将近10亿人次的就诊记录中抽样调查了28332人次。

结果发现2015年门诊医疗中抗生素的使用率为13.2%。根据国际疾病分类第9次临床修订版(ICD-9-CM),1.3亿张处方中,57%为适应症,25%为非适应症,18%没有记录任何症状。这相当于大约有2400万张处方没有记录抗生素适应症。成年男性、看病时间久、非初级保健专家接诊的情况下,更有可能开具无适应症的抗生素。且在没有记录适应症的情况下,更容易开具磺胺类药物和泌尿系统抗感染药物。

这项具有全国代表性的门诊访问研究发现大量的抗生素处方并没有记录适应症,这可能会严重影响国家对抗生素使用状况的估计。

附:英文原文

Title: Antibiotic prescribing without documented indication in ambulatory care clinics: national cross sectional study

Author: Michael J Ray, Gregory B Tallman, David T Bearden, Miriam R Elman, Jessina C McGregor

Issue&Volume: 2019/12/11

Abstract:

Objectives To identify the frequency with which antibiotics are prescribed in the absence of a documented indication in the ambulatory care setting, to quantify the potential effect on assessments of appropriateness of antibiotics, and to understand patient, provider, and visit level characteristics associated with antibiotic prescribing without a documented indication.
 
Design Cross sectional study.
 
Setting 2015 National Ambulatory Medical Care Survey.
 
Participants 28?332 sample visits representing 990.9 million ambulatory care visits nationwide.
 
Main outcome measures Overall antibiotic prescribing and whether each antibiotic prescription was accompanied by appropriate, inappropriate, or no documented indication as identified through ICD-9-CM (international classification of diseases, 9th revision, clinical modification) codes. Survey weighted multivariable logistic regression was used to evaluate potential risk factors for receipt of an antibiotic prescription without a documented indication.
 
Results Antibiotics were prescribed during 13.2% (95% confidence interval 11.6% to 13.7%) of the estimated 990.8 million ambulatory care visits in 2015. According to the criteria, 57% (52% to 62%) of the 130.5 million prescriptions were for appropriate indications, 25% (21% to 29%) were inappropriate, and 18% (15% to 22%) had no documented indication. This corresponds to an estimated 24 million prescriptions without a documented indication. Being an adult male, spending more time with the provider, and seeing a non-primary care specialist were significantly positively associated with antibiotic prescribing without an indication. Sulfonamides and urinary anti-infective agents were the antibiotic classes most likely to be prescribed without documentation.
 
Conclusions This nationally representative study of ambulatory visits identified a large number of prescriptions for antibiotics without a documented indication. Antibiotic prescribing in the absence of a documented indication may severely bias national estimates of appropriate antibiotic use in this setting. This study identified a wide range of factors associated with antibiotic prescribing without a documented indication, which may be useful in directing initiatives aimed at supporting better documentation.

DOI: 10.1136/bmj.l6461

Source: https://www.bmj.com/content/367/bmj.l6461

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj