Non-Visit-Based and Non-Infection-Related Antibiotic Use in the US: A Cohort Study of Privately Insured Patients During 2016-2018.
Non-Visit-Based and Non-Infection-Related Antibiotic Use in the US: A Cohort Study of Privately Insured Patients During 2016-2018.
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美国非访问性和非感染相关抗生素的使用：2016 - 2018年期间对私人保险患者的队列研究。
DOI：
10.1093/ofid/ofab412
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发表时间：
2021-09
影响因子：
4.2
通讯作者：
Linder JA
中科院分区：
文献类型：
--
作者：
Fischer MA;Mahesri M;Lii J;Linder JA
没有诊所访问或没有感染文件的门诊抗生素处方可能代表过度使用并导致不良后果。我们的目的是描述美国门诊抗生素处方，包括那些没有相关的访问或感染诊断。我们进行了一项观察性队列研究，使用了2016年4月1日至2018年6月30日在美国大型私人医疗保险计划中接受抗菌、抗生素处方的所有患者的数据。我们确定门诊抗生素处方为：(1)与临床医生就诊和感染相关诊断相关；(2)与临床医生就诊有关，但无感染相关诊断；或(3)在处方前7天内没有临床医生亲自就诊（非就诊）。然后，我们使用多变量模型评估非基于就诊的抗生素处方（NVBAPs）是否与基于就诊的抗生素不同，包括患者、临床医生或抗生素特征。该队列包括860万注册者，他们开了2230万张抗生素处方。NVBAP占31%（690万），非感染相关处方占22%（490万）。儿童的NVBAP率低于成人（0-17岁，16%；18-64岁，33%；65岁，34%）。在最常用的抗生素类别中，青霉素类的NVBAP最高（36%），头孢菌素类最低（25%），大环内酯类最低（25%）。专科医生的NVBAP率最高（38%），其次是内科医生（28%）、家庭医学（20%）和儿科医生（10%）。在多变量模型中，NVBAP与年龄增长有关，并且NVBAP在南方、基线临床就诊次数较多或患有慢性肺部疾病的患者中发生的可能性较小。超过一半的门诊抗生素使用不是基于就诊，就是与感染无关。特别是考虑到2019年冠状病毒病大流行导致的医疗保健变化，改善抗生素处方的努力必须考虑到非基于就诊和非感染相关的处方。
Ambulatory antibiotic prescriptions without a clinic visit or without documentation of infection could represent overuse and contribute to adverse outcomes. We aim to describe US ambulatory antibiotic prescribing, including those without an associated visit or infection diagnosis. We conducted an observational cohort study using data of all patients receiving antibacterial, antibiotic prescriptions from 04/01/2016 to 06/30/2018 in a large US private health insurance plan. We identified outpatient antibiotic prescriptions as (1) associated with a clinician visit and an infection-related diagnosis; (2) associated with a clinician visit but no infection-related diagnosis; or (3) not associated with an in-person clinician visit in the 7 days before the prescription (non-visit-based). We then assessed whether non-visit-based antibiotic prescriptions (NVBAPs) differed from visit-based antibiotics by patient, clinician, or antibiotic characteristics using multivariable models. The cohort included 8.6M enrollees who filled 22.3M antibiotic prescriptions. NVBAP accounted for 31% (6.9M) of fills, and non-infection-related prescribing accounted for 22% (4.9M). NVBAP rates were lower for children than for adults (0–17 years old, 16%; 18–64 years old, 33%; >65 years old, 34%). Among most commonly prescribed antibiotic classes, NVBAP was highest for penicillins (36%) and lowest for cephalosporins (25%) and macrolides (25%). Specialist physicians had the highest rate of NVBAP (38%), followed by internists (28%), family medicine (20%), and pediatricians (10%). In multivariable models, NVBAP was associated with increasing age, and NVBAP was less likely for patients in the South, those with more baseline clinical visits, or those with chronic lung disease. Over half of ambulatory antibiotic use was either non-visit-based or non-infection-related. Particularly given health care changes due to the coronavirus disease 2019 pandemic, efforts to improve antibiotic prescribing must account for non-visit-based and non-infection-related prescribing.
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