Roumie Christianne L, Halasa Natasha B, Edwards Kathryn M, Zhu Yuwei, Dittus Robert S, Griffin Marie R
Quality Scholars Program, Veterans Administration Tennessee Valley Healthcare System-Health Services Research and Development, Nashville, Tennessee, USA.
Am J Med. 2005 Jun;118(6):641-8. doi: 10.1016/j.amjmed.2005.02.013.
State legislatures have increased the prescribing capabilities of nurse practitioners and physician assistants and broadened the scope of their practice roles. To determine the impact of these changes, we compared outpatient antibiotic prescribing by practicing physicians, nonphysician clinicians, and resident physicians.
Using the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS), we conducted a cross-sectional study of patients >/=18 years of age receiving care in 3 outpatient settings: office practices, hospital practices, and emergency departments, 1995-2000. We measured the proportion of all visits and visits for respiratory diagnoses where antibiotics are rarely indicated in which an antibiotic was prescribed by practitioner type.
For all patient visits, nonphysician clinicians were more likely to prescribe antibiotics than practicing physicians for visits in office practices (26.3% vs 16.2%), emergency departments (23.8% vs 18.2%), and hospital clinics (25.2% vs 14.6%). Similarly, for the subset of visits for respiratory conditions where antibiotics are rarely indicated, nonphysician clinicians prescribed antibiotics more often than practicing physicians in office practices (odds ratio [OR] 1.86, 95% confidence intervals [CI]: 1.05 to 3.29), and in hospital practices (OR 1.55, 95% CI: 1.12 to 2.15). In hospital practices, resident physicians had lower prescribing rates than practicing physicians for all visits as well as visits for respiratory conditions where antibiotics are rarely indicated (OR 0.56, 95% CI: 0.36 to 0.86).
Nonphysician clinicians were more likely to prescribe antibiotics than practicing physicians in outpatient settings, and resident physicians were less likely to prescribe antibiotics. These differences suggest that general educational campaigns to reduce antibiotic prescribing have not reached all providers.
各州立法机构提高了执业护士和医师助理的处方权，并扩大了他们的执业范围。为了确定这些变化的影响，我们比较了执业医师、非医师临床医生和住院医师的门诊抗生素处方情况。
利用国家门诊医疗调查（NAMCS）和国家医院门诊医疗调查（NHAMCS），我们对1995 - 2000年在三种门诊环境（诊所、医院门诊和急诊科）接受治疗的18岁及以上患者进行了一项横断面研究。我们测量了所有就诊以及呼吸道诊断就诊（此类诊断很少需要使用抗生素）中按执业者类型开具抗生素处方的比例。
对于所有患者就诊，在诊所（26.3%对16.2%）、急诊科（23.8%对18.2%）和医院门诊（25.2%对14.6%），非医师临床医生比执业医师更有可能开具抗生素。同样，对于很少需要使用抗生素的呼吸道疾病就诊子集，在诊所（比值比[OR]1.86，95%置信区间[CI]：1.05至3.29）和医院门诊（OR 1.55，95% CI：1.12至2.15）中，非医师临床医生比执业医师更常开具抗生素。在医院门诊，住院医师在所有就诊以及很少需要使用抗生素的呼吸道疾病就诊中的处方率低于执业医师（OR 0.56，95% CI：0.36至0.86）。
在门诊环境中，非医师临床医生比执业医师更有可能开具抗生素，而住院医师开具抗生素的可能性较小。这些差异表明，旨在减少抗生素处方的一般教育活动并未覆盖所有医疗服务提供者。
