Evaluation of the Quality of Antibiotic Prescribing in Primary Care: A Multicenter Longitudinal Study From Shenzhen, China.
Evaluation of the Quality of Antibiotic Prescribing in Primary Care: A Multicenter Longitudinal Study From Shenzhen, China.
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初级保健抗生素处方质量评估：来自中国深圳的多中心纵向研究
DOI：
10.3389/fphar.2020.617260
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发表时间：
2020
影响因子：
5.6
通讯作者：
Yin X
中科院分区：
文献类型：
--
作者：
Gong Y;Li H;Yang H;Tan K;Liu W;Li X;Wu J;Zhang G;Yin X
背景：目前，尚无基于纵向数据对中国基层医疗机构抗生素处方质量的综合评价。方法：随机选取深圳市11家社区卫生中心，收集其2010 - 2015年所有门诊处方。为了评价抗菌药物的处方质量，我们采用6个质量指标进行分析，包括每100次就诊的抗菌药物数量、广谱与窄谱抗菌药物之比（B/N比）、指南推荐的一线抗菌药物百分比、持续时间超过指南推荐的口服抗菌药物百分比、新的儿科特异性指标，如阿莫西林抗生素的百分比（A指数）和阿莫西林与广谱抗生素的比率（A/B比）。结果：在研究期间，571,362例门诊患者获得抗生素处方，其中含有706,411种抗生素。每百次就诊总抗生素数由2010年的93.50例下降至2015年的19.98例（p = 0.004），但B/N随时间的推移呈上升趋势（p = 0.009）。在不同人群、不同常见感染中，抗生素使用数量均有不同程度下降，而B/N比均有不同程度上升，以<5岁儿童变化最明显。常见感染一线抗生素使用率不高，2014-2015年为3.45% ~ 44.25%。口服抗生素持续时间超标的比例为0.70% ~ 19.39%。儿童A指数和A/B比率长期处于较低水平，2015年分别为0.76%和0.01。结论：对中国深圳抗生素处方的回顾显示，在初级保健中抗生素的使用大幅减少。但广谱抗生素使用普遍、一线抗生素使用不足、阿莫西林使用率低等问题普遍存在。提高和优化抗生素处方的质量，特别是儿童处方的质量，将是中国未来抗生素管理的重点。
Background: Currently, there is no comprehensive evaluation of the quality of antibiotic prescribing in China’s primary care facilities based on longitudinal data. Methods: We randomly selected 11 community health centers in Shenzhen, China, and collected all outpatient prescriptions of these centers from 2010 to 2015. To evaluate the quality of antibiotic prescribing, we used six quality indicators for analysis, including number of antibiotics per 100 consultations, ratio between broad-spectrum and narrow-spectrum antibiotics (B/N ratio), percentage of first-line antibiotics recommended by guidelines, percentage of oral antibiotics with a duration exceeding the guideline recommendation, and new pediatric-specific indicators such as percentage of antibiotics with amoxicillin (A index) and ratio between amoxicillin and broad-spectrum antibiotics (A/B ratio). Results: During the study period, 571,362 outpatient consultations resulted in antibiotic prescriptions, which contained 706,411 antibiotics. The overall number of antibiotics per 100 consultations decreased significantly from 93.50 in 2010 to 19.98 in 2015 (p = 0.004), but the B/N ratio showed an upward trend over time (p = 0.009). In different populations and different common infections, the number of antibiotics used decreased to varying degrees, while the B/N ratio increased to varying degrees, with the most obvious change in children <5 years. The percentage of first-line antibiotics for common infections was not high, ranging from 3.45 to 44.25% during 2014–2015. The percentage of oral antibiotics with an exceeded duration ranged from 0.70 to 19.39%. Moreover, the A index and A/B ratio in children remained low for a long time, which was 0.76% and 0.01 in 2015. Conclusion: A review of antibiotic prescribing in Shenzhen, China, showed a substantial reduction in antibiotic use in primary care. However, problems such as widespread use of broad-spectrum antibiotics, insufficient use of first-line antibiotics and low use of amoxicillin were prevalent. Improving and optimizing the quality of antibiotic prescribing, particularly in children prescriptions, will be the focus of future antibiotic stewardship in China.
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影响因子：
11.8
作者：
Xiao, Yonghong
通讯作者：
Xiao, Yonghong
影响因子：
5.6
作者：
Robertson, Jane;Iwamoto, Kotoji;Pedersen, Hanne Bak
通讯作者：
Pedersen, Hanne Bak
影响因子：
5.2
作者：
Lin, Hai;Dyar, Oliver James;Lundborg, Cecilia Stalsby
通讯作者：
Lundborg, Cecilia Stalsby
影响因子：
5.5
作者：
Liu, Chenxi;Liu, Chaojie;Zhang, Xinping
通讯作者：
Zhang, Xinping
影响因子：
10
作者：
Harris, Michael;Clark, Julia;Thomson, Anne
通讯作者：
Thomson, Anne