Antibiotic prescribing for common infections in UK general practice: variability and drivers
Antibiotic prescribing for common infections in UK general practice: variability and drivers
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DOI：
10.1093/jac/dkz163
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发表时间：
2019-08-01
影响因子：
5.2
通讯作者：
van Staa, Tjeerd
中科院分区：
文献类型：
--
作者：
Palin, Victoria;Molter, Anna;van Staa, Tjeerd
目的：为了研究在英国的初级保健，以确定潜在的目标，改善和优化的prescribing.Methods：口服抗生素处方常见感染的一般做法和相关因素的变化进行了分析，使用匿名的英国初级保健电子健康记录在2000年和2015年之间使用的临床实践研究数据链（CPRD）。随着时间的推移，观察每种疾病的处方率，并将平均变化点与国家指南更新进行比较。在实践中估计每种感染性疾病的处方率之间的任何相关性。预测处方估计使用逻辑回归匹配的患者队列（1：1的年龄，性别和日历时间）。结果：超过800万例患者的记录，在587英国的一般做法进行了检查。实践在他们开抗生素的倾向上差异很大，这种差异随着时间的推移而增加。处方的变化点并没有反映国家指南的更新。不同感染条件下的处方水平在实践中并不一致。抗生素使用史显著增加了接受后续抗生素的风险（在过去12个月内有三种或三种以上抗生素处方的患者增加了22%-48%），BMI较高，吸烟史和流感疫苗接种也是如此。其他司机接受抗生素变化相当大，为每一个condition.Conclusions：抗生素处方之间的做法和做法内观察到很大的差异。处方指南本身不会对处方的变化产生积极影响，这表明需要更有针对性的干预措施来优化英国的抗生素处方。
Objectives: To examine variations across general practices and factors associated with antibiotic prescribing for common infections in UK primary care to identify potential targets for improvement and optimization of prescribing.Methods: Oral antibiotic prescribing for common infections was analysed using anonymized UK primary care electronic health records between 2000 and 2015 using the Clinical Practice Research Datalink (CPRD). The rate of prescribing for each condition was observed over time and mean change points were compared with national guideline updates. Any correlation between the rate of prescribing for each infectious condition was estimated within a practice. Predictors of prescribing were estimated using logistic regression in a matched patient cohort (1:1 by age, sex and calendar time).Results: Over 8 million patient records were examined in 587 UK general practices. Practices varied considerably in their propensity to prescribe antibiotics and this variance increased over time. Change points in prescribing did not reflect updates to national guidelines. Prescribing levels within practices were not consistent for different infectious conditions. A history of antibiotic use significantly increased the risk of receiving a subsequent antibiotic (by 22%-48% for patients with three or more antibiotic prescriptions in the past 12 months), as did higher BMI, history of smoking and flu vaccinations. Other drivers for receiving an antibiotic varied considerably for each condition.Conclusions: Large variability in antibiotic prescribing between practices and within practices was observed. Prescribing guidelines alone do not positively influence a change in prescribing, suggesting more targeted interventions are required to optimize antibiotic prescribing in the UK.