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急诊科急性腹泻患者的抗生素使用:处方习惯、患者期望与患者满意度

Antibiotic use for emergency department patients with acute diarrhea: Prescribing practices, patient expectations, and patient satisfaction.

作者信息

Karras David J, Ong Samuel, Moran Gregory J, Nakase Janet, Kuehnert Matthew J, Jarvis William R, Talan David A

机构信息

Temple University School of Medicine, Philadelphia, PA 19140, USA.

出版信息

Ann Emerg Med. 2003 Dec;42(6):835-42. doi: 10.1016/s0196-0644(03)00602-4.

Abstract

STUDY OBJECTIVE

Physicians commonly prescribe antibiotics to meet patient expectations, even when antimicrobials are unnecessary. We evaluated factors emergency physicians consider in prescribing antibiotics to patients with diarrhea and examined patient expectations, physician-perceived patient expectations, and patient satisfaction.

METHODS

Adults and children presenting with acute diarrhea to 1 of 10 academic emergency departments (EDs) were enrolled in this prospective observational cohort study. Adult patients and guardians of enrolled children were asked about treatment expectations before their physician encounter and about satisfaction with their medical care at discharge. Physicians were asked about factors influencing management decisions and their perceptions of patients' expectations.

RESULTS

Of 104 patients enrolled, 25% received antibiotics. Physicians were more likely to prescribe antibiotics when features suggestive of bacterial enteritis were present (unadjusted odds ratio [OR] 2.5; 95% confidence interval [CI] 1.1 to 3.9). Physicians were also more likely to prescribe antibiotics when they believed patients expected them (unadjusted OR 2.3; 95% CI 1.1 to 4.4) but correctly identified such expectations in only 33% of instances. Satisfaction with care was reported by 100% of patients receiving antibiotics and 90% of those not receiving antibiotics (95% CI for difference of 10%, 3% to 17%).

CONCLUSION

Physicians in academic EDs prescribe antibiotics for acute diarrhea to about 1 patient in 4 and are more likely to do so if signs or symptoms compatible with bacterial enteritis are present. Physicians' assessments of patients' expectations for therapy were accurate in only 1 of 3 patients but were nevertheless associated with antibiotic prescription. Patient satisfaction was weakly associated with receipt of antibiotics.

摘要

研究目的

即使抗菌药物并无必要,医生通常也会为满足患者期望而开具抗生素处方。我们评估了急诊医生在为腹泻患者开具抗生素时所考虑的因素,并调查了患者期望、医生感知到的患者期望以及患者满意度。

方法

在10个学术性急诊科中的1个就诊的急性腹泻成人和儿童被纳入这项前瞻性观察队列研究。成年患者及入选儿童的监护人在与医生接触前被询问治疗期望,并在出院时被询问对医疗护理的满意度。医生被询问影响治疗决策的因素以及他们对患者期望的看法。

结果

在104名入选患者中,25%接受了抗生素治疗。当存在提示细菌性肠炎的特征时,医生更有可能开具抗生素(未调整优势比[OR] 2.5;95%置信区间[CI] 1.1至3.9)。当医生认为患者期望使用抗生素时,他们也更有可能开具抗生素(未调整OR 2.3;95% CI 1.1至4.4),但仅在33%的情况下能正确识别出此类期望。接受抗生素治疗的患者中有100%报告对护理满意,未接受抗生素治疗的患者中有90%报告满意(差异的95% CI为10%,3%至17%)。

结论

学术性急诊科的医生为约四分之一的急性腹泻患者开具抗生素,如果存在与细菌性肠炎相符的体征或症状,则更有可能开具。医生对患者治疗期望的评估仅在三分之一的患者中准确,但仍与抗生素处方相关。患者满意度与接受抗生素治疗的关联较弱。

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