Debets Vera Ec, Verheij Theo Jm, van der Velden Alike W
University Medical Center Utrecht, Utrecht, the Netherlands.
Br J Gen Pract. 2017 Mar;67(656):e178-e186. doi: 10.3399/bjgp17X689641.
Unnecessary and non-first-choice antibiotic prescribing is a significant problem in primary care. It is often argued that irrational prescribing is higher during out-of-hours (OOH) consultations.
To obtain insight into the quantity and quality of OOH antibiotic prescribing for commonly presented infectious diseases.
Two two-way comparisons of 1) nationally dispensed antibiotics during office hours and OOH care, using data from the Dutch Foundation of Pharmaceutical Statistics, and 2) regional prescribing quality data from 45 primary care practices from Utrecht and its vicinity, and two large OOH services in Utrecht and Woerden.
From the national data, yearly dispensed antibiotics were analysed per prescriber type, with respect to time (office hours or OOH) of prescription, types of antibiotics, and patients' age group. Regional prescribing rates, choice of antibiotic, and appropriateness of prescribing were compared for otitis media, sinusitis, tonsillitis, bronchitis, cystitis, and impetigo. Appropriateness was assessed by comparing all relevant information from medical files with the guideline recommendations.
Only 6% of GP-prescribed antibiotics were prescribed OOH. OOH, cystitis and acute otitis media presented most often. First-choice prescribing was comparable for the two settings, whereas prescribing rates were higher OOH, with comparatively more amoxicillin(/clavulanate). The appropriateness evaluation, however, revealed that overprescribing was comparable, or even lower than, for daily practice.
The suggestion that OOH antibiotic prescribing quality is worse than in daily practice does not seem founded. The higher OOH prescribing rates can be explained by a different population of presenting patients. The appropriateness of prescribing rather than prescribing rates, therefore, should be used to determine quality.
在初级医疗保健中，不必要和非首选的抗生素处方是一个重大问题。人们常常认为，非工作时间（OOH）会诊期间的不合理处方更为常见。
深入了解针对常见传染病的非工作时间抗生素处方的数量和质量。
进行两项双向比较，一是利用荷兰药物统计基金会的数据，对办公时间和非工作时间护理期间全国范围内配发的抗生素进行比较；二是比较乌得勒支及其周边地区45家初级医疗保健机构以及乌得勒支和福尔登的两家大型非工作时间服务机构的区域处方质量数据。
从全国数据中，按处方者类型、处方时间（办公时间或非工作时间）、抗生素类型以及患者年龄组分析每年配发的抗生素。比较中耳炎、鼻窦炎、扁桃体炎、支气管炎、膀胱炎和脓疱病的区域处方率、抗生素选择及处方适宜性。通过将医疗档案中的所有相关信息与指南建议进行比较来评估适宜性。
全科医生开具的抗生素中只有6%是在非工作时间开具的。非工作时间，膀胱炎和急性中耳炎最为常见。两种情况下的首选处方相当，而非工作时间的处方率更高，阿莫西林（/克拉维酸）的使用相对更多。然而，适宜性评估显示，过度处方与日常实践相当，甚至更低。
关于非工作时间抗生素处方质量比日常实践更差的说法似乎没有依据。非工作时间较高的处方率可以通过就诊患者群体的不同来解释。因此，应该用处方的适宜性而非处方率来确定质量。
