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

描述（由申请人提供）：急性呼吸道感染（阿里斯）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，以及医疗保健成本增加。减少ARI抗生素处方的干预措施取得了有限的成功，突出了了解驱动不适当处方的因素的必要性。我们认为，原因因设置和提供商类型而异。这一点很重要，因为患者接受阿里斯治疗的地点正在发生变化，从医生到执业护士，从门诊到零售诊所。 零售诊所是药店和杂货店的诊所，为阿里斯提供无预约护理。 有些人担心这种护理方式的转变会使阿里斯不适当的抗生素处方恶化;其他人认为这种转变会改善抗生素处方。 以前对这个问题的研究有限。在这项探索性研究中，有两个目的。在目标1中，我们将研究这种护理转变是否会减少或改善ARI抗生素处方。利用国家数据来源，我们将测量门诊办公室和零售诊所的医生和执业护士为阿里斯开具的抗生素处方。在目标2中，我们将开展一项调查，以更好地了解在不同护理场所导致不适当抗生素处方的因素。我们将试点测试和验证ARI供应商调查，（a）使用临床小插曲来判断抗生素处方的质量和（B）检查是什么因素驱动抗生素处方的变化。我们将通过比较晕影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。 这两个目标的结果将为对全国样本提供者进行更大规模的研究奠定基础，以了解是什么因素导致抗生素处方的变化。第一个目标的结果可能会突出提供者和护理站点之间的重要质量差异。第二个目标将支持开发一个经过验证的小插曲调查，该调查可用于检查在护理场所，地理区域和提供者类型中驱动不适当抗生素处方的因素。我们希望，未来的工作将导致有针对性和量身定制的干预措施，以尽量减少不适当的抗生素处方。 这项研究代表了一个新课题的首批研究之一，并可能导致在一个明确的公共卫生重要性问题上的重要突破，即阿里斯不适当的抗生素处方。 公共卫生相关性：先前的研究表明，抗生素处方过于频繁的急性呼吸道疾病，如鼻窦炎或喉咙痛。现时有更多急性呼吸系统疾病的病人在门诊部和零售诊所接受执业护士的护理，有些人担心这会增加不适当地处方抗生素的病人人数。在这项研究中，我们将看到情况是否如此。我们还将开展一项调查，以研究为什么供应商不适当地处方抗生素。这项工作可以在未来用于定制干预措施，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.