Antibiotic prescribing for respiratory infections: a cross-sectional analysis of the ReCEnT study exploring the habits of early-career doctors in primary care
Antibiotic prescribing for respiratory infections: a cross-sectional analysis of the ReCEnT study exploring the habits of early-career doctors in primary care
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DOI：
10.1093/fampra/cmu069
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发表时间：
2015-02-01
期刊：
影响因子：
2.2
通讯作者：
van Driel, Mieke
中科院分区：
文献类型：
--
作者：
Dallas, Anthea;Magin, Parker;van Driel, Mieke
背景：抗生素耐药性是当前最重要的公共卫生问题之一。大多数抗生素都是在初级保健中处方的。有强烈的共识，他们是过度处方，特别是对条件，如上呼吸道感染（URTI）和急性支气管炎，他们提供有限的好处。改变处方模式的干预措施效果有限。在家庭实践中的学员可能是一个适当的目标，因为他们的处方习惯仍在发展中。目的：建立流行率和协会的培训生处方抗生素URTI和急性支气管炎/bronchiolitis.Methods：一个横断面分析的注册临床遭遇培训（ReCEnT）研究。ReCEnT是一项正在进行的澳大利亚全科医学（GP）学员队列研究，记录了他们基于咨询的临床经验的性质。受训者每6个月的培训期记录60个连续患者接触的详细情况。对2010- 2012年6个收集期的URTI和急性支气管炎/毛细支气管炎相关咨询资料进行单因素分析和Logistic回归分析。结果：共收集401名学员的资料，应答率为94.7%。21.6%的URTI患者和73.1%的急性支气管炎/细支气管炎患者使用抗生素。开抗生素处方的受训者更有可能要求进行测试，并寻求咨询意见。Logistic回归分析显示，老年患者的年龄，土著患者的背景，并在较高的社会经济领域的做法是显着的预测因素抗生素prescribing.Conclusion：GP实习生抗生素处方高于合理的指南。了解导致这种模式的因素将有助于制定教育干预措施，以改善这些医生职业生涯早期阶段的循证处方习惯。
Background: Antibiotic resistance is among the most important current public health issues. Most antibiotics are prescribed in primary care. There is strong consensus that they are overprescribed, especially for conditions such as upper respiratory tract infections (URTI) and acute bronchitis, where they provide limited benefit. Interventions to alter prescribing patterns have shown limited effect. Trainees in family practice may be an appropriate target, as their prescribing habits are still developing.Objective: To establish prevalence and associations of trainee prescribing of antibiotics for URTI and acute bronchitis/bronchiolitis.Methods: A cross-sectional analysis of the Registrar Clinical Encounters in Training (ReCEnT) study. ReCEnT is an ongoing cohort study of Australian General Practice (GP) trainees documenting the nature of their consultation-based clinical experiences. Trainees record details of 60 consecutive patient encounters every 6-month training term. Univariate and logistic regression analyses were conducted on data recorded in consultations related to URTI and acute bronchitis/bronchiolitis in six collection periods during 2010-12.Results: Data from 401 trainees (94.7% response rate) were analysed. Antibiotics were prescribed in 21.6% of encounters for URTI and 73.1% of encounters for acute bronchitis/bronchiolitis. Trainees prescribing antibiotics were more likely to order tests, and to seek inconsultation advice. Logistic regression analysis demonstrated older patient age, Indigenous patient background, and practices in higher socioeconomic areas were significant predictors of antibiotic prescribing.Conclusion: GP trainee antibiotic prescribing is higher than justified by guidelines. Understanding factors contributing to this pattern will assist in developing educational interventions to improve evidence-based prescribing habits during the early stages of these doctors' careers.