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（ARIs）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。这些处方中的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和卫生保健费用增加。减少ARI抗生素处方的干预措施取得了有限的成功，这突出表明需要了解导致不当处方的因素。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ARIs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里的诊所，为急性呼吸道感染患者提供免预约治疗。一些人表示担心，这种护理的转变将加剧急性呼吸道感染的不适当抗生素处方；其他人则认为，这一转变将改善抗生素处方。关于这一主题的先前研究有限。在这个探索性研究中，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抗生素处方。使用国家数据来源，我们将测量门诊和零售诊所的医生和执业护士对急性呼吸道感染的抗生素处方。在目标2中，我们将开展一项调查，可用于更好地了解不同护理地点导致不适当抗生素处方的因素。我们将试点测试和验证ARI提供者调查，该调查(a)使用临床小片段来判断抗生素处方的质量，(b)检查驱动抗生素处方变化的因素。我们将通过比较小图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在全国范围内对供应商样本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项有效的小插曲调查，该调查可用于检查导致护理地点、地理区域和提供者类型之间不适当的抗生素处方的因素。我们的希望是，这项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。这项研究是对一个新主题的首批研究之一，可能会在一个具有明显公共卫生重要性的问题上取得重大突破，即对急性呼吸道感染的不适当抗生素处方。

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.