Antibiotic prescriptions in the community by type of provider in the United States, 2005-2010
Antibiotic prescriptions in the community by type of provider in the United States, 2005-2010
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DOI：
10.1016/j.japh.2016.08.015
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发表时间：
2016-11-01
影响因子：
2.1
通讯作者：
Taylor, Thomas H.
中科院分区：
文献类型：
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作者：
Suda, Katie J.;Roberts, Rebecca M.;Taylor, Thomas H.
目的：尽管美国的抗生素处方正在减少，但广谱处方正在增加。目前尚不清楚在国家抗生素处方中观察到的减少是否因供应商群体而异。了解供应商群体随时间推移的处方趋势有助于定制抗菌药物管理工作。因此，本研究的目的是描述门诊抗生素处方的提供者组整体和人口和供应商的数量进行调整。此外，按类别和季节变化的处方趋势由提供者组描述超过6年。设计：门诊抗生素处方的横断面观察。设置和参与者：使用IMS Health Xponent数据集对2005年至2010年美国处方的人群水平分析。主要结果指标：总体和按提供者组分配的处方数量和比率。结果：大多数（81.0%）抗生素由医生处方，其次是牙医（10.4%）、执业护士（NP; 4.5%）和医师助理（PA; 4.2%）。医生的抗生素处方百分比下降，但NP和PA显着增加。医生和牙医的基于提供者和基于人口的处方率下降，NP和PA的处方率增加。青霉素类处方最频繁的所有供应商群体，减少医生和牙医。观察到NP和PA的广谱药物处方增加。除牙医外，抗生素处方在冬季高于夏季，最大的季节性增加NPs.Conclusion：在6年多的时间里，抗生素处方的整体和广谱药物减少了医生和增加了NP和PA。因此，美国广谱抗生素处方的增加趋势可以归因于中级供应商。干预措施的设计应扭转日益增加的处方趋势，特别是由NP和PA处方的广谱药物。管理工作还应针对牙医，因为与中等水平的提供者相比，这一群体开的抗生素比例更高。爱思唯尔公司出版代表美国药剂师协会
Objectives: Although antibiotic prescriptions are decreasing in the United States, broad-spectrum prescribing is increasing. It is unknown if decreases observed in national antibiotic prescribing differ by provider group. Understanding prescribing trends over time by provider group can be helpful for customizing antimicrobial stewardship efforts. Therefore, the purposes of this study were to describe outpatient antibiotic prescribing by provider group overall and adjusted for population and number of providers. In addition, trends in prescribing by class and seasonal variation are described by provider group over 6 years.Design: Cross-sectional observation of outpatient antibiotic prescriptions.Setting and participants: A population-level analysis of U.S. prescribing from 2005 to 2010 with the use of the IMS Health Xponent dataset.Main outcome measures: Number and rates of prescriptions dispensed overall and by provider group.Results: The majority (81.0%) of antibiotics were prescribed by physicians, followed by dentists (10.4%), nurse practitioners (NPs; 4.5%), and physician assistants (PAs; 4.2%). The percentage of antibiotic prescriptions decreased for physicians, but increased significantly for NPs and PAs. Provider-based and population-based prescribing rates decreased for physicians and dentists and increased for NPs and PAs. Penicillins were prescribed most frequently by all provider groups, decreasing for physicians and dentists. Increased prescribing of broad-spectrum agents was observed for NPs and PAs. With the exception of dentists, antibiotic prescriptions were higher in winter than in summer, with the largest seasonal increase by NPs.Conclusion: Over 6 years, antibiotic prescriptions overall and for broad-spectrum agents decreased for physicians and increased for NPs and PAs. Thus, increasing trends in the US of broad-spectrum antibiotic prescriptions can be attributed to midlevel providers. Interventions should be designed to reverse increasing prescribing trends, especially of broad-spectrum agents prescribed by NPs and PAs. Stewardship efforts should also be targeted towards dentists, since this group prescribes a higher proportion of antibiotics compared with midlevel providers. Published by Elsevier Inc. on behalf of the American Pharmacists Association.