Bergmark Regan W, Sedaghat Ahmad R
Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A..
Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A.
Laryngoscope. 2016 Nov;126(11):2439-2444. doi: 10.1002/lary.26001. Epub 2016 Apr 14.
OBJECTIVES/HYPOTHESIS: We have previously identified patient characteristics associated with emergency department (ED) rather than primary-care provider (PCP) presentation for uncomplicated acute rhinosinusitis (ARS). Here we investigate potential disparities in prescription of antibiotics for patients presenting to a PCP versus ED for uncomplicated ARS.
Cross-sectional study of the 2005 to 2010 National Ambulatory Medical Care Surveys and National Hospital Ambulatory Medical Care Surveys.
A total of 37,975,715 patient presentations for uncomplicated ARS to PCPs and EDs. The primary outcome measure was prescription of an oral antibiotic, which was tested for association with clinical setting (PCP vs. ED) and clinical, demographic, and socioeconomic patient characteristics.
Among adult ARS presentations, 57.0% received an antibiotic prescription from a PCP versus 59.1% in the ED. Pediatric patients also were commonly prescribed antibiotics by PCPs (52.9%) and EDs (51.4%). Compared to PCPs, EDs were not associated with antibiotic prescription for adults (odds ratio [OR] = 1.09, 95% confidence interval [CI]: 0.79-1.50, P = 0.613) or children (OR = 0.94, 95% CI: 0.51-1.72, P = 0.840). Among PCP visits, antibiotic prescription was more likely in the Northeast United States (OR = 2.90, 95% CI: .31-6.38, P = 0.009). No other demographic, clinical, or socioeconomic patient characteristics, including insurance status, were associated with antibiotic prescription by PCPs or EDs.
More than half of ARS patients presenting to PCPs and EDs are prescribed antibiotics. There was no differential antibiotic prescription for ED versus PCP presentation. ARS patients in the Northeast were more likely to receive antibiotics from PCPs, whereas no such variation was seen for EDs. Interventions targeting PCPs, especially in the Northeast, may reduce excessive antibiotic utilization.
目的/假设：我们之前已确定了与因单纯性急性鼻-鼻窦炎（ARS）前往急诊科（ED）而非初级保健提供者（PCP）处就诊相关的患者特征。在此，我们调查因单纯性ARS前往PCP处与前往ED就诊的患者在抗生素处方方面的潜在差异。
对2005年至2010年国家门诊医疗保健调查和国家医院门诊医疗保健调查进行横断面研究。
共有37975715例因单纯性ARS前往PCP处和ED就诊的患者。主要结局指标为口服抗生素的处方情况，对其与临床就诊地点（PCP vs. ED）以及患者的临床、人口统计学和社会经济特征之间的关联进行了测试。
在成年ARS患者中，57.0%从PCP处获得了抗生素处方，而在ED就诊的患者中这一比例为59.1%。儿科患者从PCP处（52.9%）和ED处（51.4%）获得抗生素处方的情况也较为常见。与PCP相比，ED与成人（优势比[OR]=1.09，95%置信区间[CI]：0.79 - 1.50，P = 0.613）或儿童（OR = 0.94，95% CI：0.51 - 1.72，P = 0.840）的抗生素处方无关。在PCP就诊中，美国东北部开具抗生素处方的可能性更高（OR = 2.90，95% CI：2.31 - 6.38，P = 0.009）。包括保险状况在内，没有其他患者的人口统计学、临床或社会经济特征与PCP或ED开具抗生素处方有关。
超过半数因ARS前往PCP处和ED就诊的患者都被开具了抗生素。ED就诊与PCP就诊在抗生素处方方面没有差异。美国东北部的ARS患者从PCP处获得抗生素的可能性更高，而在ED就诊的患者中未观察到此类差异。针对PCP的干预措施，尤其是在东北部，可能会减少抗生素的过度使用。
4。《喉镜》，126:2439 - 2444，2016年。
