Unnecessary antibiotic prescribing in a Canadian primary care setting: a descriptive analysis using routinely collected electronic medical record data.
Unnecessary antibiotic prescribing in a Canadian primary care setting: a descriptive analysis using routinely collected electronic medical record data.
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DOI：
10.9778/cmajo.20190175
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发表时间：
2020-04-01
期刊：
影响因子：
--
通讯作者：
Garber, Gary
中科院分区：
文献类型：
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作者：
Schwartz, Kevin L;Langford, Bradley J;Garber, Gary
背景：加拿大社区中不必要的抗生素使用没有明确的定义。我们的目标是量化加拿大初级保健环境中不必要的抗生素处方。方法：我们使用电子医疗记录初级保健数据库链接到ICES的其他卫生管理数据集，从2011年4月到2016年3月在安大略省进行了描述性分析。我们确定了23种常见疾病的抗生素处方率(每100次患者-医生会诊)，并使用预先定义的预期处方率(按病情和患者年龄组分层)估计了不必要的处方率。结果：这项研究包括341名医生、204 313名患者和499 570次就诊。纳入病种不必要抗生素处方的比例为15.4%，其中2岁以下为17.6%，2-18岁为18.6%，19-为14.5%，65岁以上为13.0%。急性支气管炎(52.6%)、急性鼻窦炎(48.4%)和急性中耳炎(39.3%)是不必要处方的最高比例。普通感冒、急性支气管炎、急性鼻窦炎和各种非细菌性感染占不必要抗菌药物处方的80%。在所有抗生素处方中，12.0%用于从未指明用于治疗的情况，12.3%用于很少说明用于治疗的情况。在儿童中，25%的抗生素用于从未指明的疾病(例如，普通感冒)。干预：在加拿大初级保健环境中，15.4%的遭遇不必要地开了抗生素。几乎四分之一的抗生素是针对很少或从来没有指明的情况而开的。这些发现应该可以安全地减少普通感冒、支气管炎和鼻窦炎的抗生素使用。
BACKGROUND: Unnecessary antibiotic use in the community in Canada is not well defined. Our objective was to quantify unnecessary antibiotic prescribing in a Canadian primary care setting.METHODS: We performed a descriptive analysis in Ontario from April 2011 to March 2016 using the Electronic Medical Records Primary Care database linked to other health administrative data sets at ICES. We determined antibiotic prescribing rates (per 100 patient-physician encounters) for 23 common conditions and estimated rates of unnecessary prescribing using predefined expected prescribing rates, both stratified by condition and patient age group.RESULTS: The study included 341 physicians, 204 313 patients and 499 570 encounters. The rate of unnecessary antibiotic prescribing for included conditions was 15.4% overall and was 17.6% for those less than 2 years of age, 18.6% for those aged 2-18, 14.5% for those aged 19-64 and 13.0% for those aged 65 or more. The highest unnecessary prescribing rates were observed for acute bronchitis (52.6%), acute sinusitis (48.4%) and acute otitis media (39.3%). The common cold, acute bronchitis, acute sinusitis and miscellaneous nonbacterial infections were responsible for 80% of the unnecessary antibiotic prescriptions. Of all antibiotics prescribed, 12.0% were for conditions for which they are never indicated, and 12.3% for conditions for which they are rarely indicated. In children, 25% of antibiotics were for conditions for which they are never indicated (e.g., common cold).INTERPRETATION: Antibiotics were prescribed unnecessarily for 15.4% of included encounters in a Canadian primary care setting. Almost one-quarter of antibiotics were prescribed for conditions for which they are rarely or never indicated. These findings should guide safe reductions in the use of antibiotics for the common cold, bronchitis and sinusitis.