Appropriateness of Outpatient Antibiotic Use in Seniors across Two Canadian Provinces.
Appropriateness of Outpatient Antibiotic Use in Seniors across Two Canadian Provinces.
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DOI：
10.3390/antibiotics10121484
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发表时间：
2021-12-03
期刊：
影响因子：
--
通讯作者：
Marra F
中科院分区：
文献类型：
--
作者：
Saatchi A;Reid JN;Povitz M;Shariff SZ;Silverman M;Morris AM;Reyes RC;Patrick DM;Marra F
抗菌药物是加拿大最常用的药物之一，超过 90% 的抗生素是在门诊开出的。老年人服用抗菌药物特别容易受到药物不良事件和抗菌药物耐药性的影响。加拿大门诊医疗实践中抗生素处方不当的程度以及这种实践的潜在长期趋势尚不清楚。这项研究是加拿大首次检查两个大型省级医疗保健系统的处方质量，以比较老年人门诊抗生素使用的数量和质量。在不列颠哥伦比亚省 (BC) 和安大略省 (ON) 使用行政健康数据库进行了基于人群的分析，并确定了 2000 年 1 月 1 日至 2018 年 12 月 31 日期间向老年人（≥65 岁）配发的所有门诊口服抗菌药物。使用三级层次结构将抗菌药物与适应症联系起来。始终需要抗生素的一级适应症被优先考虑，其次是有时需要抗生素的二级适应症，然后是从不需要抗生素的三级适应症。按每 1000 人计算处方率，并按药物类别和患者人口统计数据检查总体趋势。两个省份的处方数量保持稳定，BC 省总共发放了 11,166,401 份处方，安大略省总共发放了 27,656,014 份处方。在整个研究期间，与 ON（范围：每 1000 名居民 745 至 785 例）相比，BC 的处方率略有升高（范围：每 1000 名居民 790 至 930 例）。对于这两个省份来说，三级诊断是抗生素使用的最常见原因，占所有适应症相关抗生素处方的 50%。尽管在整个研究期间，第 3 级适应症仍然是最常用的诊断，但随着时间的推移，其下降趋势令人鼓舞，并且仍有很大的改进空间。加拿大门诊机构对老年人的处方数量持续增加，处方质量受到高度关注，50% 的抗菌药物处方不适用于不需要抗菌药物的常见感染。
Antimicrobials are among the most prescribed medications in Canada, with over 90% of antibiotics prescribed in outpatient settings. Seniors prescribed antimicrobials are particularly vulnerable to adverse drug events and antimicrobial resistance. The extent of inappropriate antibiotic prescribing in outpatient Canadian medical practice, and the potential long-term trends in this practice, are unknown. This study is the first in Canada to examine prescribing quality across two large-scale provincial healthcare systems to compare both quantity and quality of outpatient antibiotic use in seniors. Population-based analyses using administrative health databases were conducted in British Columbia (BC) and Ontario (ON), and all outpatient, oral antimicrobials dispensed to seniors (≥65 years) from 1 January 2000 to 31 December 2018 were identified. Antimicrobials were linked to an indication using a 3-tiered hierarchy. Tier 1 indications, which always require antibiotics, were given priority, followed by Tier 2 indications that sometimes require antibiotics, then Tier 3, which never require antibiotics. Prescription rates were calculated per 1000 population, and trends were examined overall, by drug class, and by patient demographics. Prescribing remained steady in both provinces, with 11,166,401 prescriptions dispensed overall in BC, and 27,656,014 overall in ON. BC prescribed at slightly elevated rates (range: 790 to 930 per 1000 residents), in comparison to ON (range: 745 to 785 per 1000 residents), throughout the study period. For both provinces, a Tier 3 diagnosis was the most common reason for antibiotic use, accounting for 50% of all indication-associated antibiotic prescribing. Although Tier 3 indications remained the most prescribed-for diagnoses throughout the study period, a declining trend over time is encouraging, with much room for improvement remaining. Elevated prescribing to seniors continues across Canadian outpatient settings, and prescribing quality is of high concern, with 50% of all antimicrobials prescribed inappropriately for common infections that do not require antimicrobials.
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影响因子：
3.4
作者：
Saatchi A;Morris AM;Patrick DM;Mccormack J;Reyes RC;Morehouse P;Reid J;Shariff S;Povitz M;Silverman M;Marra F
通讯作者：
Marra F
DOI：
10.1155/2011/745090
发表时间：
2011-03-01
影响因子：
2.8
作者：
McKay, Rachel M.;Vrbova, Linda;Patrick, David M.
通讯作者：
Patrick, David M.
影响因子：
120.7
作者：
Fleming-Dutra, Katherine E.;Hersh, Adam L.;Hicks, Lauri A.
通讯作者：
Hicks, Lauri A.
DOI：
10.9778/cmajo.20190175
发表时间：
2020-04-01
期刊：
CMAJ open
影响因子：
--
作者：
Schwartz, Kevin L;Langford, Bradley J;Garber, Gary
通讯作者：
Garber, Gary
影响因子：
39.2
作者：
Silverman, Michael;Povitz, Marcus;Shariff, Salimah Z.
通讯作者：
Shariff, Salimah Z.