Aspinall Sherrie L, Metlay Joshua P, Maselli Judith H, Gonzales Ralph
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, and Unviersity of Pittsburgh School of Pharmacy, Pittsburgh, PA 15240, USA.
Am J Manag Care. 2007 May;13(5):241-8.
To examine factors associated with fluoroquinolone prescribing among adults receiving antibiotics for acute respiratory tract infections (ARIs) in emergency departments.
Cross-sectional.
We analyzed data from 8 Department of Veterans Affairs medical centers and 7 nonfederal US hospitals. At each hospital, we randomly sampled 200 ARI visits with International Classification of Diseases, Ninth Revision discharge diagnoses for nonspecific upper respiratory infections, acute bronchitis, pharyngitis, sinusitis, and pneumonia between November 1, 2003, and February 29, 2004. Patient and provider factors associated with each visit were extracted from medical records. System characteristics were obtained by surveying pharmacy directors. Multivariable logistic regression was used to evaluate independent predictors of fluoroquinolone prescribing.
Fluoroquinolones accounted for 14% of these prescriptions. At hospitals with at least 1 unrestricted fluoroquinolone on formulary (n = 12), the average fluoroquinolone prescription rate was 17%, compared with a 6% prescription rate at hospitals where fluoroquinolone access was restricted by the hospital formulary (n = 3) (P < .0001). Factors associated with increased fluoroquinolone prescription rates were hospital admission (odds ratio [OR] = 1.8; 95% confidence interval [CI] = 1.1, 3.1) and the diagnoses of acute bronchitis (OR = 2.3; 95% CI = 1.3, 4.2), acute exacerbations of chronic bronchitis (OR = 2.6; 95% CI = 1.2, 5.6), and pneumonia (OR = 6.4; 95% CI = 3.3, 12.4). Restricted hospital status was associated with decreased fluoroquinolones accounted for 14% of the antibiotic prescriptions.
Hospital formulary policies represent a potentially important target for influencing outpatient drug prescribing in emergency departments.
研究急诊科中因急性呼吸道感染（ARI）接受抗生素治疗的成年人中与氟喹诺酮类药物处方相关的因素。
横断面研究。
我们分析了来自8家退伍军人事务部医疗中心和7家非联邦美国医院的数据。在每家医院，我们从2003年11月1日至2004年2月29日期间因非特异性上呼吸道感染、急性支气管炎、咽炎、鼻窦炎和肺炎而进行国际疾病分类第九版出院诊断的ARI就诊病例中随机抽取200例。从病历中提取与每次就诊相关的患者和医护人员因素。通过对药房主任进行调查获取系统特征。采用多变量逻辑回归评估氟喹诺酮类药物处方的独立预测因素。
氟喹诺酮类药物占这些处方的14%。在处方集上至少有一种无限制使用的氟喹诺酮类药物的医院（n = 12），氟喹诺酮类药物的平均处方率为17%，而在医院处方集限制氟喹诺酮类药物使用的医院（n = 3），处方率为6%（P <.0001）。与氟喹诺酮类药物处方率增加相关的因素包括住院（比值比[OR] = 1.8；95%置信区间[CI] = 1.1，3.1）以及急性支气管炎（OR = 2.3；95% CI = 1.3，4.2）、慢性支气管炎急性加重（OR = 2.6；95% CI = 1.2，5.6）和肺炎（OR = 6.4；95% CI = 3.3，12.4）的诊断。医院的限制状态与氟喹诺酮类药物处方率降低相关，氟喹诺酮类药物占抗生素处方的14%。
医院处方集政策是影响急诊科门诊药物处方的一个潜在重要目标。
