诊断标签作为全科医疗中急性呼吸道疾病抗生素处方的决定因素。
Diagnostic labelling as determinant of antibiotic prescribing for acute respiratory tract episodes in general practice.
作者信息
van Duijn Huug J, Kuyvenhoven Marijke M, Tiebosch Hanneke M, Schellevis François G, Verheij Theo J M
机构信息
Julius Center for Health Sciences and Primary Care, University Medical Center, Location Stratenum, room 6,109, PO Box 85060, 3508 AB Utrecht, The Netherlands.
出版信息
BMC Fam Pract. 2007 Sep 20;8:55. doi: 10.1186/1471-2296-8-55.
BACKGROUND
Next to other GP characteristics, diagnostic labelling (the proportion of acute respiratory tract (RT) episodes to be labelled as infections) probably contributes to a higher volume of antibiotic prescriptions for acute RT episodes. However, it is unknown whether there is an independent association between diagnostic labelling and the volume of prescribed antibiotics, or whether diagnostic labelling is associated with the number of presented acute RT episodes and consequently with the number of antibiotics prescribed per patient per year.
METHODS
Data were used from the Second Dutch National Survey of General Practice (DNSGP-2) with 163 GPs from 85 Dutch practices, serving a population of 359,625 patients. Data over a 12 month period were analysed by means of multiple linear regression analysis. Main outcome measure was the volume of antibiotic prescriptions for acute RT episodes per 1,000 patients.
RESULTS
The incidence was 236.9 acute RT episodes/1,000 patients. GPs labelled about 70% of acute RT episodes as infections, and antibiotics were prescribed in 41% of all acute RT episodes. A higher incidence of acute RT episodes (beta 0.67), a stronger inclination to label episodes as infections (beta 0.24), a stronger endorsement of the need of antibiotics in case of white spots in the throat (beta 0.11) and being male (beta 0.11) were independent determinants of the prescribed volume of antibiotics for acute RT episodes, whereas diagnostic labelling was not correlated with the incidence of acute RT episodes.
CONCLUSION
Diagnostic labelling is a relevant factor in GPs' antibiotic prescribing independent from the incidence of acute RT episodes. Therefore, quality assurance programs and postgraduate courses should emphasise to use evidence based prognostic criteria (e.g. chronic respiratory co-morbidity and old age) as an indication to prescribe antibiotics in stead of single inflammation signs or diagnostic labels.
背景
除其他全科医生特征外，诊断标签（急性呼吸道（RT）发作被标记为感染的比例）可能导致急性RT发作的抗生素处方量增加。然而，尚不清楚诊断标签与抗生素处方量之间是否存在独立关联，或者诊断标签是否与急性RT发作的就诊次数相关，进而与每位患者每年的抗生素处方数量相关。
方法
使用来自第二次荷兰全国全科医学调查（DNSGP - 2）的数据，该调查涉及来自85家荷兰诊所的163名全科医生，服务于359,625名患者。通过多元线性回归分析对12个月期间的数据进行分析。主要结局指标是每1000名患者急性RT发作的抗生素处方量。
结果
发病率为每1000名患者236.9次急性RT发作。全科医生将约70%的急性RT发作标记为感染，并且在所有急性RT发作中有41%开具了抗生素。急性RT发作的较高发病率（β = 0.67）、将发作标记为感染的更强倾向（β = 0.24）、对喉咙有白点时使用抗生素必要性的更强认可（β = 0.11）以及男性（β = 0.11）是急性RT发作抗生素处方量的独立决定因素，而诊断标签与急性RT发作的发病率无关。
结论
诊断标签是全科医生抗生素处方中的一个相关因素，独立于急性RT发作的发病率。因此，质量保证计划和研究生课程应强调使用基于证据的预后标准（如慢性呼吸道合并症和老年）作为开具抗生素的指征，而不是单一的炎症体征或诊断标签。
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