英国全科医疗中的牙科会诊与抗生素处方率：一项回顾性队列研究。
Dental consultations in UK general practice and antibiotic prescribing rates: a retrospective cohort study.
作者信息
Cope Anwen L, Chestnutt Ivor G, Wood Fiona, Francis Nick A
机构信息
Cardiff and Vale University Health Board, University Dental Hospital, Cardiff.
Professor and honorary consultant in dental public health, School of Dentistry;
出版信息
Br J Gen Pract. 2016 May;66(646):e329-36. doi: 10.3399/bjgp16X684757. Epub 2016 Mar 29.
BACKGROUND
The frequency of consulting for dental problems in general medical practice, and antibiotic prescribing associated with these consultations, is poorly described.
AIM
To describe consultation rates and antibiotic use for dental problems in UK general medical practice, and explore factors associated with antibiotic prescribing for dental conditions.
DESIGN AND SETTING
A retrospective cohort study using Clinical Practice Research Datalink, a database of general practice patient records in the UK.
METHOD
All dental consultations between 2004 and 2013 were identified. The main outcome was the prescription of an antibiotic during a dental consultation. Multilevel logistic regression was conducted to examine factors associated with antibiotic prescription.
RESULTS
In all, 288 169 dental consultations were included in the cohort. The average rate of dental consultations was 6.06 consultations per 1000 patient-years. Rates of dental consultation decreased from 6.84 consultations per 1000 patient-years in 2008, to 4.23 consultations per 1000 patient-years in 2013. Consultation rates were higher among females than males and highest in patients aged 20-29 years. An antibiotic was prescribed in 57.1% of consultations. Significant predictors (P<0.001) of antibiotic prescribing included: patient middle age, male sex, and previous consultations for tooth-related problems. Antibiotics were more likely to be prescribed during consultations in December (odds ratio [OR] 1.18, 95% confidence interval [CI] = 1.13 to 1.24, P<0.001, reference month: June) and on a Monday (OR 1.10, 95% CI = 1.07 to 1.13, P<0.001) or a Friday (OR 1.15, 95% CI = 1.12 to 1.18, P<0.001, reference day: Wednesday).
CONCLUSION
Consultation rates for dental problems in UK general practice are relatively low but more than half result in the prescription of an antibiotic. This raises concerns about patient morbidity and contributions to antimicrobial resistance.
背景
在普通医疗实践中，因牙齿问题进行咨询的频率以及与这些咨询相关的抗生素处方情况，目前描述得并不充分。
目的
描述英国普通医疗实践中因牙齿问题的咨询率及抗生素使用情况，并探究与牙齿疾病抗生素处方相关的因素。
设计与研究背景
一项回顾性队列研究，使用临床实践研究数据链（英国普通医疗患者记录数据库）。
方法
确定2004年至2013年间所有的牙齿咨询情况。主要观察指标是牙齿咨询期间抗生素的处方情况。进行多水平逻辑回归分析以检查与抗生素处方相关的因素。
结果
该队列共纳入288169例牙齿咨询。牙齿咨询的平均率为每1000患者年6.06次咨询。牙齿咨询率从2008年的每1000患者年6.84次咨询降至2013年的每1000患者年4.23次咨询。女性的咨询率高于男性，20 - 29岁患者的咨询率最高。57.1%的咨询中开具了抗生素。抗生素处方的显著预测因素（P<0.001）包括：患者中年、男性以及既往因牙齿相关问题的咨询。在12月的咨询中更有可能开具抗生素（比值比[OR]1.18，95%置信区间[CI]=1.13至1.24，P<0.001，参照月份：6月），以及在周一（OR 1.10，95% CI = 1.07至1.13，P<0.001）或周五（OR 1.15，95% CI = 1.12至1.18，P<0.001，参照日期：周三）的咨询中。
结论
英国普通医疗实践中牙齿问题的咨询率相对较低，但超过一半的咨询会导致抗生素处方。这引发了对患者发病率以及对抗菌素耐药性影响的担忧。
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