Quality of antibiotic prescribing of Swiss primary care physicians with high prescription rates: a nationwide survey
Quality of antibiotic prescribing of Swiss primary care physicians with high prescription rates: a nationwide survey
复制标题
DOI：
10.1093/jac/dkx278
复制
发表时间：
2017-11-01
影响因子：
5.2
通讯作者：
Hemkens, Lars G.
中科院分区：
文献类型：
--
作者：
Glinz, Dominik;Reyes, Selene Leon;Hemkens, Lars G.
目的：评价高处方率的瑞士初级保健医生的抗生素处方质量。方法：2015年1月，我们向瑞士2900名初级保健医生邮寄了一份结构化问卷。他们被纳入了一项全国性的务实随机对照试验，该试验基于医疗保险索赔数据，对常规抗生素处方进行监测和反馈。我们要求他们记录连续44名患者的诊断和抗生素治疗情况，这些患者最常见的情况与初级保健中使用抗生素有关。结果：250名医生(8.6%)做出了回应，提供了9,961份病历。应答者与整个医生群体相似。总体而言，32.1%的患者开了抗生素。扁桃体炎/咽炎、急性中耳炎、急性鼻窦炎和急性支气管炎的抗生素处方超标率分别为24.4%、49.6%、27.4%和11.5%。对于所有诊断，非推荐使用抗生素的比例超过推荐的最高20%(在所有情况下为31.5%-88.7%)。37.2%的女性尿路感染患者使用了喹诺酮类药物，大大超过了5%的推荐上限。结论：瑞士初级保健医生的抗生素处方质量较低，扁桃体炎/咽炎、急性鼻窦炎、急性中耳炎和急性支气管炎的处方质量较低。有必要在全国范围内对抗生素的使用进行常规和持续的监测，并采取具体的干预措施，以改善初级保健中的处方情况。
Objectives: To assess the quality of antibiotic prescribing of Swiss primary care physicians with high prescription rates.Methods: In January 2015, we mailed a structured questionnaire to 2900 primary care physicians in Switzerland. They were included in a nationwide pragmatic randomized controlled trial on routine antibiotic prescription monitoring and feedback based on health insurance claims data. We asked them to record the diagnosis and antibiotic treatment for 44 consecutive patients with the most common conditions associated with antibiotic prescribing in primary care. We evaluated if the disease-specific antibiotic prescribing and the proportion of nonrecommended antibiotics used, in particular quinolones, were within 'acceptable ranges' using adapted European Surveillance of Antimicrobial Consumption (ESAC) quality indicators.Results: Two hundred and fifty physicians (8.6%) responded, providing 9961 patient records. Responders were similar to the entire physician population. Overall, antibiotics were prescribed to 32.1% of patients. For tonsillitis/pharyngitis, acute otitis media, acute rhinosinusitis and acute bronchitis the acceptable maximum of antibiotic prescriptions was exceeded by 24.4%, 49.6%, 27.4% and 11.5%, respectively. The proportion of nonrecommended antibiotics was for all diagnoses above the recommended maximum of 20% (31.5%-88.7% across all conditions). Quinolones were prescribed to 37.2% of women with urinary tract infections, substantially exceeding the recommended maximumof 5%.Conclusions: Antibiotic prescribing quality of Swiss primary care physicians with high prescription rates is low according to the indicators used, with substantial overtreatment of tonsillitis/pharyngitis, acute rhinosinusitis, acute otitis media and acute bronchitis. Routine nationwide and continuous monitoring of antibiotic use and specific interventions are warranted to improve prescribing in primary care.