Alsan Marcella, Morden Nancy E, Gottlieb Joshua D, Zhou Weiping, Skinner Jonathan
*Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA †National Bureau of Economic Research, Cambridge, MA ‡Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH §Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH ∥Vancouver School of Economics, University of British Columbia, Vancouver, BC, Canada ¶Department of Economics, Dartmouth College, Hanover, NH.
Med Care. 2015 Dec;53(12):1066-71. doi: 10.1097/MLR.0000000000000440.
Excessive antibiotic use in cold and flu season is costly and contributes to antibiotic resistance. The study objective was to develop an index of excessive antibiotic use in cold and flu season and determine its correlation with other indicators of prescribing quality.
We included Medicare beneficiaries in the 40% random sample denominator file continuously enrolled in fee-for-service benefits for 2010 or 2011 (7,961,201 person-years) and extracted data on prescription fills for oral antibiotics that treat respiratory pathogens. We collapsed the data to the state level so they could be merged with monthly flu activity data from the Centers for Disease Control and Prevention. Linear regression, adjusted for state-specific mean antibiotic use and demographic characteristics, was used to estimate how antibiotic prescribing responded to state-specific flu activity. Flu-activity associated antibiotic use varied substantially across states-lowest in Vermont and Connecticut, highest in Mississippi and Florida. There was a robust positive correlation between flu-activity associated prescribing and use of medications that often cause adverse events in the elderly (0.755; P<0.001), whereas there was a strong negative correlation with beta-blocker use after a myocardial infarction (-0.413; P=0.003).
Adjusted flu-activity associated antibiotic use was positively correlated with prescribing high-risk medications to the elderly and negatively correlated with beta-blocker use after myocardial infarction. These findings suggest that excessive antibiotic use reflects low-quality prescribing. They imply that practice and policy solutions should go beyond narrow, antibiotic specific, approaches to encourage evidence-based prescribing for the elderly Medicare population.
在感冒和流感季节过度使用抗生素成本高昂，并会导致抗生素耐药性。本研究的目的是制定一个感冒和流感季节抗生素过度使用指数，并确定其与其他处方质量指标的相关性。
我们纳入了2010年或2011年连续参保按服务付费福利的40%随机抽样分母文件中的医疗保险受益人（7961201人年），并提取了治疗呼吸道病原体的口服抗生素处方填充数据。我们将数据汇总到州层面，以便与疾病控制和预防中心的每月流感活动数据合并。采用针对各州特定平均抗生素使用情况和人口统计学特征进行调整的线性回归，来估计抗生素处方如何应对各州特定的流感活动。与流感活动相关的抗生素使用在各州之间差异很大——佛蒙特州和康涅狄格州最低，密西西比州和佛罗里达州最高。与流感活动相关的处方与老年人中经常导致不良事件的药物使用之间存在强烈的正相关（0.755；P<0.001），而与心肌梗死后β受体阻滞剂的使用存在强烈的负相关（-0.413；P=0.003）。
调整后的与流感活动相关的抗生素使用与给老年人开高风险药物呈正相关，与心肌梗死后β受体阻滞剂的使用呈负相关。这些发现表明，抗生素的过度使用反映了低质量的处方。这意味着实践和政策解决方案不应局限于狭隘的、特定于抗生素的方法，而应鼓励为老年医疗保险人群进行循证处方。
