Antibiotic Prescribing for Acute Respiratory Infections: Impact of Shifts in Care

描述(申请人提供)：急性呼吸道感染(ARI)是美国患者寻求治疗的最常见原因，占所有抗生素处方的大部分。这些处方中有很大一部分是不适当的，导致抗生素耐药性增加，不必要的药物并发症，以及医疗费用增加。减少ARI抗生素处方的干预措施成效有限，这突显了了解驱动不适当处方的因素的必要性。我们认为，不同的设置和不同类型的提供商，原因各不相同。这一点很重要，因为ARIS患者接受护理的地方正在从内科医生转向护士从业者，从门诊诊所转向零售诊所。零售诊所是药店和杂货店的诊所，为ARIS提供无需预约的护理。一些人表示担心，这种护理转变将加剧ARIS不适当的抗生素处方；另一些人认为，这种转变将改善抗生素处方。关于这一主题的先前研究有限。在这次探索性研究中，有两个目的。在目标1中，我们将研究这种护理转变是否会恶化或改善ARI抗生素的处方。利用国家数据来源，我们将衡量门诊办公室和零售诊所的医生和护士为ARI开出的抗生素处方。在目标2中，我们将开发一项调查，可以用来更好地了解不同护理地点不适当开抗生素的驱动因素。我们将对ARI供应商的一项调查进行试点测试和验证，该调查(A)使用临床片段来判断抗生素处方的质量，(B)检查哪些因素导致抗生素处方的变化。我们将通过比较Vignette测量的抗生素处方质量和图表测量的抗生素处方质量来验证调查。这两个目标的结果加在一起，将为对供应商进行更大规模的研究奠定基础，以了解哪些因素导致抗生素处方的差异。第一个目标的结果可能会突出不同提供者和护理地点的重要质量差异。第二个目标将支持开发有效的Vignette调查，该调查可用于检查跨护理地点、地理区域和提供者类型的不适当抗生素处方的驱动因素。我们希望，这项未来的工作将导致有针对性的、量身定做的干预措施，以尽量减少不适当的抗生素处方。这项研究是对一个新主题的首批研究之一，并可能在一个具有明显公共卫生重要性的问题上取得重要突破，即对ARIS不适当的抗生素处方。 与公共卫生相关：先前的研究表明，抗生素在治疗鼻窦炎或喉咙痛等急性呼吸道疾病时开得太频繁了。现在，越来越多的患者在门诊部和零售诊所接受执业护士对急性呼吸道疾病的护理，一些人担心这会增加不适当开抗生素的患者的数量。在这项研究中，我们将看看情况是否如此。我们还将开发一项调查，可以用来研究为什么供应商不适当地开抗生素。这项工作可以在未来用于量身定做干预措施，以改善抗生素处方。

DESCRIPTION (provided by applicant): Acute respiratory tract infections (ARIs) are the most common reason patients seek care in the United States and account for the majority of all antibiotic prescriptions. A large fraction of these prescriptions are inappropriate resulting in increased antibiotic resistance, unnecessary drug complications, and increased health care costs. Interventions to decrease ARI antibiotic prescribing have had limited success, highlighting the need to understand the factors that drive inappropriate prescribing. We believe that the reasons vary across settings and by type of provider. This is important because there is an ongoing shift in where patients receive care for ARIs from physicians to nurse practitioners and from outpatient practices to retail clinics. Retail clinics are clinics in drug stores and grocery stores that provide walk-in care for ARIs. Some have expressed concern that this shift in care will worsen inappropriate antibiotic prescribing for ARIs; others believe this shift will improve antibiotic prescribing. There has been limited prior research on this topic. In this exploratory study, there are two aims. In Aim 1, we will study whether this shift in care worsens or improves ARI antibiotic prescribing. Using national data sources we will measure antibiotic prescribing for ARIs by physicians and nurse practitioners at outpatient offices and retail clinics. In Aim 2, we will develop a survey that can be used to better understand the factors driving inappropriate antibiotic prescribing at different care sites. We will pilot test and validate an ARI provider survey that (a) uses clinical vignettes to judge the quality of antibiotic prescribing and (b) examines what factors drive the variation in antibiotic prescribing. We will validate the survey by comparing vignette- measured antibiotic prescribing quality to chart-measured antibiotic prescribing quality. Together the results of the two aims will provide the foundation for a larger study of a national sample of providers to see what factors drive variation in antibiotic prescribing. The results of the first aim may highlight important quality differences across providers and care sites. The second aim will support the development of a validated vignette survey, which can be used to examine factors that drive inappropriate antibiotic prescribing across care sites, geographic regions, and provider types. Our hope is that this future work will lead to targeted and tailored interventions to minimize inappropriate antibiotic prescribing. The study represents one of the first studies on a novel topic and might lead to important breakthroughs on an issue of clear public health importance, inappropriate antibiotic prescribing for ARIs. PUBLIC HEALTH RELEVANCE: Prior research has shown that antibiotics are prescribed too often for acute respiratory illnesses such as sinusitis or sore throat. More patients are now receiving care for acute respiratory illnesses from nurse practitioners at outpatient offices and retail clinics and some are worried that this will increase the number of patients who are inappropriately prescribed antibiotics. In this study we will see if this is the case. We will also develop a survey that can be used to study why providers inappropriately prescribe antibiotics. The work can be used in the future to tailor interventions to improve antibiotic prescribing.