Antibiotic Prescribing for Nonbacterial Acute Upper Respiratory Infections in Elderly Persons
Antibiotic Prescribing for Nonbacterial Acute Upper Respiratory Infections in Elderly Persons
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DOI：
10.7326/m16-1131
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发表时间：
2017-06-06
影响因子：
39.2
通讯作者：
Shariff, Salimah Z.
中科院分区：
文献类型：
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作者：
Silverman, Michael;Povitz, Marcus;Shariff, Salimah Z.
背景：减少急性上呼吸道感染(AURIS)不适当的抗生素处方需要更好地了解与这种做法相关的因素。目的：确定非细菌性AURI的抗生素处方的流行率以及开药率是否因医生特征而异。设计：相关行政卫生保健数据的回顾分析。地点：加拿大安大略省的初级保健医生执业(2012年1月至12月)。患者：66岁或以上的非细菌性AURI患者。患有癌症或免疫抑制的患者和长期疗养院的居民被排除在外。衡量标准：医生诊断的Auris的抗生素处方。结果：队列中有8990名初级保健医生和185 014名患者出现非细菌性AURI，包括普通感冒(53.4%)、急性支气管炎(31.3%)、急性鼻窦炎(13.6%)和急性喉炎(1.6%)。46%的患者接受了抗生素处方；大多数处方是广谱药物(69.9%[95%CI，69.6%至70.2%])。患者更有可能从职业生涯中期和职业生涯后期的医生那里获得处方，而不是职业生涯早期的医生(比率差异分别为5.1个百分点[CI，3.9至6.4个百分点]和4.6个百分点[CI，3.3至5.8个百分点])，来自加拿大或美国以外培训的医生(3.6个百分点[CI，2.5至4.6个百分点])，每天看25到44个病人或45个或更多病人的医生比每天看不到25个病人的病人多(分别为3.1个百分点[CI，2.1~4.0个百分点]和4.1个百分点[CI，2.7~5.5个百分点])。限制：医生开处方的理由尚不清楚。结论：在这个低风险的老年队列中，46%的非细菌性AURI患者服用了抗生素。患者更有可能从职业生涯中后期的高病人数量的医生那里获得处方，以及从在加拿大或美国以外接受培训的医生那里获得处方。主要资金来源：安大略省卫生和长期护理部、安大略省西南学术医疗组织、舒利赫医学和牙科学院、西部大学和劳森健康研究所。
Background: Reducing inappropriate antibiotic prescribing for acute upper respiratory tract infections (AURIs) requires a better understanding of the factors associated with this practice.Objective: To determine the prevalence of antibiotic prescribing for nonbacterial AURIs and whether prescribing rates varied by physician characteristics.Design: Retrospective analysis of linked administrative health care data.Setting: Primary care physician practices in Ontario, Canada (January-December 2012).Patients: Patients aged 66 years or older with nonbacterial AURIs. Patients with cancer or immunosuppressive conditions and residents of long-term care homes were excluded.Measurements: Antibiotic prescriptions for physician-diagnosed AURIs. A multivariable logistic regression model with generalized estimating equations was used to examine whether prescribing rates varied by physician characteristics, accounting for clustering of patients among physicians and adjusting for patient-level covariates.Results: The cohort included 8990 primary care physicians and 185 014 patients who presented with a nonbacterial AURI, including the common cold (53.4%), acute bronchitis (31.3%), acute sinusitis (13.6%), or acute laryngitis (1.6%). Forty-six percent of patients received an antibiotic prescription; most prescriptions were for broad-spectrum agents (69.9% [95% CI, 69.6% to 70.2%]). Patients were more likely to receive prescriptions from mid- and late-career physicians than early-career physicians (rate difference, 5.1 percentage points [CI, 3.9 to 6.4 percentage points] and 4.6 percentage points [CI, 3.3 to 5.8 percentage points], respectively), from physicians trained outside of Canada or the United States (3.6 percentage points [CI, 2.5 to 4.6 percentage points]), and from physicians who saw 25 to 44 patients per day or 45 or more patients per day than those who saw fewer than 25 patients per day (3.1 percentage points [CI, 2.1 to 4.0 percentage points] and 4.1 percentage points [CI, 2.7 to 5.5 percentage points], respectively).Limitation: Physician rationale for prescribing was unknown.Conclusion: In this low-risk elderly cohort, 46% of patients with a nonbacterial AURI were prescribed antibiotics. Patients were more likely to receive prescriptions from mid-or late-career physicians with high patient volumes and from physicians who were trained outside of Canada or the United States.Primary Funding Source: Ontario Ministry of Health and Longterm Care, Academic Medical Organization of Southwestern Ontario, Schulich School of Medicine and Dentistry, Western University, and Lawson Health Research Institute.