Ciofi degli Atti Marta Luisa, Massari Marco, Bella Antonino, Boccia Delia, Filia Antonietta, Salmaso Stefania
Reparto Malattie Infettive, Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanita', Viale Regina Elena 299, 00161 Rome, Italy.
Eur J Clin Pharmacol. 2006 Dec;62(12):1055-64. doi: 10.1007/s00228-006-0198-8. Epub 2006 Oct 5.
Collecting information on patterns of drug prescriptions and on factors influencing prescribing decisions is fundamental for supporting the rational use of drugs. This study was aimed at investigating patterns of drug prescription in paediatric outpatients and at evaluating determinants of prescriptions for respiratory tract infections (RTIs).
We conducted a national cross-sectional survey involving primary care paediatricians and parents. Diagnoses and prescriptions made at each consultation were described. Poisson regression models were used to analyse determinants of drug and antibiotic prescriptions for visits due to RTIs.
A total of 4,302 physician and parent questionnaires were analysed. These corresponded to 2,151 visits, 792 of which were due to RTIs. Drugs were prescribed in 83.4% of RTI visits, while antibiotics were prescribed in 40.4%. According to paediatricians' perceptions, 84.2% of parents of children with a RTI expected to receive a drug prescription. Paediatricians' perception of parental expectations was the strongest determinant for prescription of drugs and specifically of antibiotics [adjusted relative risk (RR): 1.7 and 3.6, respectively; P < 0.001]. However, in 77.1% of RTI visits, paediatricians judged themselves as not being influenced at all by parents' expectations in their decision to prescribe.
This study underscores that relational factors, in particular perceived parental expectations, are one of the leading factors of drug prescriptions in paediatric ambulatory care settings, reinforcing the opinion that communication between physicians and parents can affect prescription patterns.
收集药物处方模式及影响处方决策因素的信息，对于支持合理用药至关重要。本研究旨在调查儿科门诊患者的药物处方模式，并评估呼吸道感染（RTIs）处方的决定因素。
我们开展了一项全国性横断面调查，涉及基层儿科医生和家长。描述了每次会诊时做出的诊断和处方。采用泊松回归模型分析因RTIs就诊时药物和抗生素处方的决定因素。
共分析了4302份医生和家长问卷。这些问卷对应2151次就诊，其中792次是因RTIs就诊。83.4%的RTIs就诊开具了药物，40.4%开具了抗生素。根据儿科医生的认知，84.2%的RTIs患儿家长期望获得药物处方。儿科医生对家长期望的认知是药物特别是抗生素处方的最强决定因素[调整相对风险（RR）：分别为1.7和3.6；P<0.001]。然而，在77.1%的RTIs就诊中，儿科医生认为自己在开处方的决定中完全没有受到家长期望的影响。
本研究强调，关系因素，特别是感知到的家长期望，是儿科门诊护理环境中药物处方的主要因素之一，强化了医生与家长之间的沟通会影响处方模式的观点。
