A retrospective audit of antibiotic prescriptions in primary health-care facilities in Eastern Region, Ghana.
A retrospective audit of antibiotic prescriptions in primary health-care facilities in Eastern Region, Ghana.
复制标题
对加纳东部地区初级卫生保健机构抗生素处方的回顾性审计。
DOI：
10.1093/heapol/czv048
复制
发表时间：
2016-03
影响因子：
3.2
通讯作者：
Magnussen P
中科院分区：
文献类型：
--
作者：
Ahiabu MA;Tersbøl BP;Biritwum R;Bygbjerg IC;Magnussen P
全球对抗生素的抗药性正在增加，并对公共健康构成威胁。研究表明，抗生素的使用与耐药性的发展之间存在相关性。发展中国家受耐药性的影响最大，因为传染病负担高，获得有质量保证的抗生素的机会有限，以及更理想的药物和糟糕的抗生素使用做法。适当使用抗生素以减缓耐药性发展的步伐是至关重要的。这项研究使用世卫组织/国际合理用药网络合理用药指标，对加纳东部地区四个公立和私立初级保健机构的抗生素处方做法进行了回顾性评估。使用系统抽样程序，在2010年4月至2011年3月期间，每个机构选择了400张处方。描述性分析评价合理用药指标，Logistic回归分析抗生素处方的预测因素。平均每次就诊处方数为4.01张，59.9%的处方使用抗生素，24.2%的处方使用针剂。其中，仿制药占79.2%，国家基本药物目录占88.1%。在多因素分析中，卫生机构类型(优势比[OR] = 2.0 5；95%可信区间[CI]：1.42，2.95)、患者年龄(OR = 0.97；95%CI：0.97，0.98)、处方用药数量(OR = 1.85；95%CI：1.63，2.10)和处方上的“不吃疟疾药”(OR = 5.05；95%CI：2.08，12.2 5)与抗生素处方有关。上呼吸道感染的诊断与抗生素的使用呈正相关。抗生素的使用水平因卫生设施类型的不同而有所不同，与2008年估计的全国平均水平相比普遍偏高。应考虑在疾病管理中减少诊断不确定性的干预措施。国家健康保险计划作为加纳医疗服务的主要购买者，提供了一个应该加以利用的机会，以推出支持合理用药的政策。
Resistance to antibiotics is increasing globally and is a threat to public health. Research has demonstrated a correlation between antibiotic use and resistance development. Developing countries are the most affected by resistance because of high infectious disease burden, limited access to quality assured antibiotics and more optimal drugs and poor antibiotic use practices. The appropriate use of antibiotics to slow the pace of resistance development is crucial. The study retrospectively assessed antibiotic prescription practices in four public and private primary health-care facilities in Eastern Region, Ghana using the WHO/International Network for the Rational Use of Drugs rational drug use indicators. Using a systematic sampling procedure, 400 prescriptions were selected per facility for the period April 2010 to March 2011. Rational drug use indicators were assessed in the descriptive analysis and logistic regression was used to explore for predictors of antibiotic prescription. Average number of medicines prescribed per encounter was 4.01, and 59.9% of prescriptions had antibiotics whilst 24.2% had injections. In total, 79.2% and 88.1% of prescribed medicines were generics and from the national essential medicine list, respectively. In the multivariate analysis, health facility type (odds ratio [OR] = 2.05; 95% confidence interval [CI]: 1.42, 2.95), patient age (OR = 0.97; 95% CI: 0.97, 0.98), number of medicines on a prescription (OR = 1.85; 95% CI: 1.63, 2.10) and ‘no malaria drug’ on prescription (OR = 5.05; 95% CI: 2.08, 12.25) were associated with an antibiotic prescription. A diagnosis of upper respiratory tract infection was positively associated with antibiotic use. The level of antibiotic use varied depending on the health facility type and was generally high compared with the national average estimated in 2008. Interventions that reduce diagnostic uncertainty in illness management should be considered. The National Health Insurance Scheme, as the main purchaser of health services in Ghana, offers an opportunity that should be exploited to introduce policies in support of rational drug use.