Late-career Physicians Prescribe Longer Courses of Antibiotics
Late-career Physicians Prescribe Longer Courses of Antibiotics
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DOI：
10.1093/cid/ciy1130
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发表时间：
2019-11-01
影响因子：
11.8
通讯作者：
Schwartz, Kevin L.
中科院分区：
文献类型：
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作者：
Fernandez-Lazaro, Cesar, I;Brown, Kevin A.;Schwartz, Kevin L.
背景抗生素的持续时间往往比必要的时间长。了解抗生素使用时间差异的原因可以为减少抗生素长期使用的干预措施提供信息。我们的目的是描述处方抗生素治疗持续时间的医生间变异模式，并确定社区环境中延长抗生素治疗持续时间的医生预测因素。我们使用IQVIA的Xponent数据集，对2016年3月1日至2017年2月28日期间加拿大安大略的家庭医生进行了回顾性队列分析。主要结果是延长抗生素疗程的比例，定义为治疗>8天。我们使用多变量逻辑回归模型，广义估计方程来解释医生水平的聚类，以评估抗生素疗程延长的预测因素。共有10616名家庭医生参与了这项研究，开出了560万个抗生素疗程。在延长抗生素疗程的比例方面，医生之间存在很大差异（中位数，33.3%;十分位数范围，13.5%-60.3%）。在多变量回归模型中，较晚的医生职业阶段，农村地区，以及更大的儿科实践显着相关，更多地使用延长课程。与早期职业医生相比，后期职业医生（调整后的比值比[aOR]，1.48; 95%可信区间，1.38-1.58）和中期职业医生（aOR，1.25; 1.16-1.34）更有可能开长期疗程的处方。我们观察到家庭医生的处方抗生素持续时间存在很大差异，职业后期医生的持续时间特别长。这些发现强调了社区抗菌药物管理干预的机会，通过解决后期职业医生的实践差异来改善抗生素的使用。
Background. Antibiotic duration is often longer than necessary. Understanding the reasons for variability in antibiotic duration can inform interventions to reduce prolonged antibiotic use. We aim to describe patterns of interphysician variability in prescribed antibiotic treatment durations and determine physician predictors of prolonged antibiotic duration in the community setting.Methods. We performed a retrospective cohort analysis of family physicians in Ontario, Canada, between 1 March 2016 and 28 February 2017, using the Xponent dataset from IQVIA. The primary outcome was proportion of prolonged antibiotic course prescribed, defined as >8 days of therapy. We used multivariable logistic regression models, with generalized estimating equations to account for physician-level clustering to evaluate predictors of prolonged antibiotic courses.Results. There were 10 616 family physicians included in the study, prescribing 5.6 million antibiotic courses. There was substantial interphysician variability in the proportion of prolonged antibiotic courses (median, 33.3%; interdecile range, 13.5%-60.3%). In the multivariable regression model, later physician career stage, rural location, and a larger pediatric practice were significantly associated with greater use of prolonged courses. Prolonged courses were more likely to be prescribed by late-career physicians (adjusted odds ratio [aOR], 1.48; 95% confidence interval, 1.38-1.58) and mid-career physicians (aOR, 1.25; 1.16-1.34) when compared to early-career physicians.Conclusions. We observed substantial variability in prescribed antibiotic duration across family physicians, with durations particularly long among late-career physicians. These findings highlight opportunities for community antimicrobial stewardship interventions to improve antibiotic use by addressing practice differences in later-career physicians.