Antibiotic Prescription Fills for Acute Conjunctivitis among Enrollees in a Large United States Managed Care Network
Antibiotic Prescription Fills for Acute Conjunctivitis among Enrollees in a Large United States Managed Care Network
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DOI：
10.1016/j.ophtha.2017.04.034
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发表时间：
2017-08-01
期刊：
影响因子：
13.7
通讯作者：
Stein, Joshua D.
中科院分区：
文献类型：
--
作者：
Shekhawat, Nakul S.;Shtein, Roni M.;Stein, Joshua D.
目的：急性结膜炎很少需要抗生素治疗。我们评估了新诊断的急性结膜炎患者填写局部抗生素处方的频率以及与抗生素处方填写相关的因素。设计：回顾性观察性队列研究。参与者：2001年至2014年，美国一个大型全国性管理式护理网络中共有340372名新诊断的急性结膜炎患者。方法：我们确定了所有新诊断为急性结膜炎的入组者，计算了在首次诊断后14天内填写1个或多个局部抗生素处方的比例。多变量逻辑回归分析评估了社会人口统计学、医疗和其他与急性结膜炎抗生素处方填充相关的因素。结果：在340372例急性结膜炎患者中，198462例（58%）填写了≥ 1个局部抗生素处方; 38 774张处方用于类固醇-皮质类固醇组合产品。与白人相比，黑人（OR，0.89; 95%CI，0.86-0.92）和拉丁美洲人（OR，0.83; 95%CI，0.81-0.86）填写抗生素处方的几率较低。富裕和受教育程度较高的注册者与富裕程度和受教育程度较低的注册者相比，填写抗生素处方的几率较高（所有数据均P < 0.01）。与最初由眼科医生诊断为急性结膜炎的患者相比，如果首先由验光师诊断，则注册者有相当高的抗生素处方填充几率（OR，1.26; 95% CI，1.21-1.31），急诊医生（OR，3.29; 95%CI，3.17-3.41）、内科医生（OR，2.79; 95%CI，2.69-2.90）、儿科医生（OR，2.27; 95%CI，2.13-2.43）或家庭医生（OR，2.46; 95%CI，2.37-2.55）。抗生素处方填充对于有与没有严重感染发展风险因素的人没有差异，例如接触透镜佩戴者（P = 0.21）或人类免疫缺陷病毒感染或艾滋病患者（P = 0.60）。结论：在这个管理式护理网络中，近60%的注册者填写了急性结膜炎的抗生素处方，每5名抗生素使用者中就有1人服用了急性结膜炎禁忌的皮质类固醇。这些潜在的有害做法可能会延长感染时间，可能会促进抗生素耐药性，并增加成本。填写抗生素处方似乎更多地受到社会人口因素和诊断登记者的提供者类型的驱动，而不是医学适应症。Ophthalmology 2017; 124：10991107（C）2017美国眼科学会
Purpose: Antibiotics are seldom necessary to treat acute conjunctivitis. We assessed how frequently patients with newly diagnosed acute conjunctivitis fill prescriptions for topical antibiotics and factors associated with antibiotic prescription fills.Design: Retrospective, observational cohort study.Participants: A total of 340 372 enrollees in a large nationwide United States managed care network with newly diagnosed acute conjunctivitis, from 2001 through 2014.Methods: We identified all enrollees newly diagnosed with acute conjunctivitis, calculating the proportion filling 1 or more topical antibiotic prescription within 14 days of initial diagnosis. Multivariate logistic regression assessed sociodemographic, medical, and other factors associated with antibiotic prescription fills for acute conjunctivitis. Geographic variation in prescription fills also was studied.Main Outcome Measures: Odds ratios (ORs) with 95% confidence intervals (CIs) for filling an antibiotic prescription for acute conjunctivitis.Results: Among 340 372 enrollees with acute conjunctivitis, 198 462 (58%) filled >= 1 topical antibiotic prescriptions; 38 774 filled prescriptions for antibiotic-corticosteroid combination products. Compared with whites, blacks (OR, 0.89; 95% CI, 0.86-0.92) and Latinos (OR, 0.83; 95% CI, 0.81-0.86) had lower odds of filling antibiotic prescriptions. More affluent and educated enrollees had higher odds of filling antibiotic prescriptions compared with those with lesser affluence and education (P < 0.01 for all). Compared with persons initially diagnosed with acute conjunctivitis by ophthalmologists, enrollees had considerably higher odds of antibiotic prescription fills if first diagnosed by an optometrist (OR, 1.26; 95% CI, 1.21-1.31), urgent care physician (OR, 3.29; 95% CI, 3.17-3.41), internist (OR, 2.79; 95% CI, 2.69-2.90), pediatrician (OR, 2.27; 95% CI, 2.13-2.43), or family practitioner (OR, 2.46; 95% CI, 2.37-2.55). Antibiotic prescription fills did not differ for persons with versus without risk factors for development of serious infections, such as contact lens wearers (P = 0.21) or patients with human immunodeficiency virus infection or AIDS (P = 0.60).Conclusions: Nearly 60% of enrollees in this managed care network filled antibiotic prescriptions for acute conjunctivitis, and 1 of every 5 antibiotic users filled prescriptions for antibiotic-corticosteroids, which are contraindicated for acute conjunctivitis. These potentially harmful practices may prolong infection duration, may promote antibiotic resistance, and in crease costs. Filling antibiotic prescriptions seems to be driven more by sociodemographic factors and type of provider diagnosing the enrollee than by medical indication. Ophthalmology 2017; 124: 10991107 (C) 2017 by the American Academy of Ophthalmology