University Rovira i Virgili, Primary Healthcare Centre Jaume I, c. Felip Pedrell, 45-47, Tarragona, Catalonia 43005, Spain.
Eur Respir J. 2012 Aug;40(2):436-41. doi: 10.1183/09031936.00093211. Epub 2011 Dec 19.
This before-after study aimed to evaluate the effect of two interventions on lowering the prescription of antibiotics in lower respiratory tract infections (LRTI) in Spain. General practitioners (GPs) registered all cases with LRTIs over 3-week periods before and after an intervention, in 2008 and 2009. Two types of intervention were considered: full-intervention group (FIG), consisting of discussion sessions of the results of the first registry, courses for GPs, guidelines, patient information leaflets, workshops on rapid tests and use of the C-reactive protein (CRP) test; GPs in the partial-intervention group (PIG) underwent all of the above interventions except for the workshop on rapid tests, and they did not have access to CRP. A multilevel logistic regression analysis was performed considering the prescription of an antibiotic as the dependent variable. 210 physicians were assigned to FIG and 70 to PIG. In 2009, 58 new physicians were included as a control group. 5,385 LRTIs were registered. Compared with the control group, the OR of antibiotic prescription after the intervention in the PIG was 0.42 (95% CI: 0.22-0.82) and 0.22 (95% CI: 0.12-0.38) in the FIG. Intervention led to a reduction in the prescription of antibiotics, mainly when CRP testing was available.
这项前后对照研究旨在评估两种干预措施对降低西班牙下呼吸道感染（LRTI）处方抗生素的效果。全科医生（GPs）在 2008 年和 2009 年的三个星期的时间内，分别登记了干预前后所有 LRTI 病例。考虑了两种类型的干预措施：全干预组（FIG），包括对第一个登记处结果的讨论会议、针对 GPs 的课程、指南、患者信息传单、关于快速测试和 C-反应蛋白（CRP）测试的使用的研讨会；部分干预组（PIG）的 GPs 接受了上述所有干预措施，但不包括快速测试研讨会，并且他们无法获得 CRP。采用多水平逻辑回归分析，将抗生素处方作为因变量进行考虑。210 名医生被分配到 FIG，70 名医生被分配到 PIG。2009 年，新增了 58 名医生作为对照组。共登记了 5385 例 LRTI。与对照组相比，PIG 组在干预后的抗生素处方的 OR 为 0.42（95%CI：0.22-0.82），FIG 组为 0.22（95%CI：0.12-0.38）。干预措施导致抗生素的处方减少，主要是在 CRP 测试可用的情况下。
