Adriaenssens Niels, Coenen Samuel, Tonkin-Crine Sarah, Verheij Theo J M, Little Paul, Goossens Herman
University of Antwerp, Vaccine & Infectious Disease Institute (VAXINFECTIO), Laboratory of Medical Microbiology, Antwerp, Belgium.
BMJ Qual Saf. 2011 Sep;20(9):764-772. doi: 10.1136/bmjqs.2010.049049. Epub 2011 Mar 21.
Background In 2007, ESAC (http://www.esac.ua.ac.be) published a set of 12 valid drug-specific quality indicators for outpatient antibiotic use in Europe. In this study, the authors aimed to develop evidence-based disease-specific quality indicators for outpatient antibiotic prescribing in Europe. Methods Two meetings were convened to produce a list of disease-specific quality indicators for outpatient antibiotic prescribing which conform to internationally agreed recommendations, building on a similar development of drug-specific quality indicators, and in collaboration with CHAMP and HAPPY AUDIT. 62 experts were asked to complete two scoring rounds of the proposed indicators on seven dimensions: their relevance to (1) reducing antimicrobial resistance, (2) patient health benefit, (3) cost-effectiveness, (4) policy makers, (5) individual prescribers, (6) their evidence base and (7) their range of acceptable use, using a scale ranging from 1 (=completely disagree) to 9 (=completely agree). Scores were judged according to the UCLA-RAND appropriateness method. Results For the six main indications for antibiotic prescribing (acute otitis media, acute upper-respiratory infection, acute/chronic sinusitis, acute tonsillitis, acute bronchitis/bronchiolitis, cystitis/other urinary infection) and for pneumonia, three quality indicators were proposed, the percentage prescribed (a) antibiotics; (b) recommended antibiotics; (c) quinolones. This set was scored by 40 experts from 25 countries. After one scoring round, all indicators were already rated as relevant on all dimensions, except one. Conclusion All proposed disease-specific quality indicators for outpatient antibiotic prescribing have face validity and are potentially applicable. They could be used to better describe antibiotic use and assess the quality of antibiotic prescribing patterns in ambulatory care.
背景 2007 年，ESAC（http://www.esac.ua.ac.be）发布了一套针对欧洲门诊抗生素使用的 12 项有效的特定药物质量指标。在本研究中，作者旨在制定基于证据的欧洲门诊抗生素处方特定疾病质量指标。方法 召开了两次会议，以制定符合国际商定建议的门诊抗生素处方特定疾病质量指标清单，该清单以类似的特定药物质量指标制定为基础，并与 CHAMP 和 HAPPY AUDIT 合作。62 位专家被要求对提议的指标在七个维度上进行两轮评分：它们与（1）减少抗菌药物耐药性、（2）患者健康益处、（3）成本效益、（4）政策制定者、（5）个体开处方者、（6）其证据基础和（7）其可接受使用范围的相关性，使用从 1（=完全不同意）到 9（=完全同意）的量表。根据加州大学洛杉矶分校 - 兰德适宜性方法对分数进行评判。结果 对于抗生素处方的六个主要适应症（急性中耳炎、急性上呼吸道感染、急性/慢性鼻窦炎、急性扁桃体炎、急性支气管炎/细支气管炎、膀胱炎/其他尿路感染）以及肺炎，提出了三项质量指标，即（a）抗生素的处方百分比；（b）推荐抗生素的处方百分比；（c）喹诺酮类药物的处方百分比。这组指标由来自 25 个国家的 40 位专家进行评分。经过一轮评分后，除一项指标外，所有指标在所有维度上均已被评为相关。结论 所有提议的门诊抗生素处方特定疾病质量指标均具有表面效度且可能适用。它们可用于更好地描述抗生素使用情况并评估门诊护理中抗生素处方模式的质量。
