Crowson Matthew G, Schulz Kristine C, Tucci Debara L
Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, Durham, NC.
Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, Durham, NC.
Am J Otolaryngol. 2015 Nov-Dec;36(6):814-9. doi: 10.1016/j.amjoto.2015.07.001. Epub 2015 Jul 7.
To determine if providers prescribe more affordable topical antibacterial therapy for patients who are economically disadvantaged or come from economically disadvantaged communities.
Prescription drug database review.
Large academic hospital network.
Ototopical prescription records of 2416 adults and children presenting with acute and chronic otologic infections from 2009 to 2013 were reviewed. Prescription, patient, provider, and institution variables including diagnosis, prescription type, demographics, health insurance status, healthcare provider type and setting were analyzed.
Otitis externa and acute otitis media were the most common diagnoses. Non-OHNS (Otolaryngology-Head and Neck Surgery) providers served 82% of all patients. OHNS providers prescribed proportionally less fluoroquinolone, and more brand-name antibiotics compared to non-OHNS providers. Adults were more likely to receive a non-fluoroquinolone antibiotic and a generic prescription versus pediatric patients. Patients who self-identified as 'white' ethnicity received proportionally more fluoroquinolone prescriptions than patients who identified as 'non-white,' but there was no difference in provider type. The proportion of fluoroquinolone prescriptions was significantly higher in patients from low-poverty counties, however poverty level was not associated with patients seeing a particular provider type. The majority of our patients had commercial insurance, followed by Medicaid. Medicare patients had the lowest proportion of fluoroquinolone antibiotic prescriptions, and were less likely to receive fluoroquinolone prescriptions versus commercial insurance. Non-insured patients received proportionally more generic versus brand prescriptions than insured patients.
Our results indicate potential provider, patient demographic, and financial factors producing considerable variability in the prescribing patterns for topical antibiotics for common otologic infections.
确定医疗服务提供者是否会为经济上处于不利地位或来自经济上处于不利地位社区的患者开更经济实惠的局部抗菌治疗药物。
处方药数据库回顾。
大型学术医院网络。
回顾了2009年至2013年期间2416例患有急慢性耳科感染的成人和儿童的耳用处方记录。分析了处方、患者、医疗服务提供者和机构变量，包括诊断、处方类型、人口统计学特征、健康保险状况、医疗服务提供者类型和就诊机构。
外耳道炎和急性中耳炎是最常见的诊断。非耳鼻喉科（耳鼻咽喉头颈外科）医疗服务提供者诊治了所有患者中的82%。与非耳鼻喉科医疗服务提供者相比，耳鼻喉科医疗服务提供者按比例开具的氟喹诺酮类药物较少，而品牌抗生素较多。与儿科患者相比，成人更有可能接受非氟喹诺酮类抗生素和非专利处方。自我认定为“白人”种族的患者比认定为“非白人”的患者按比例接受更多的氟喹诺酮类处方，但在医疗服务提供者类型方面没有差异。来自低贫困县的患者中氟喹诺酮类处方的比例显著更高，然而贫困水平与患者就诊的特定医疗服务提供者类型无关。我们的大多数患者拥有商业保险，其次是医疗补助。医疗保险患者的氟喹诺酮类抗生素处方比例最低，与商业保险患者相比，他们接受氟喹诺酮类处方的可能性较小。未参保患者比参保患者按比例接受更多的非专利处方而非品牌处方。
我们的结果表明，医疗服务提供者、患者人口统计学特征和财务因素可能会导致常见耳科感染局部抗生素处方模式出现相当大的差异。
