Aabenhus Rune, Siersma Volkert, Sandholdt Håkon, Køster-Rasmussen Rasmus, Hansen Malene Plejdrup, Bjerrum Lars
Research Unit of General Practice and Section of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.
Research Unit of General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
J Antimicrob Chemother. 2017 Aug 1;72(8):2385-2391. doi: 10.1093/jac/dkx115.
In Denmark, general practice is responsible for 75% of antibiotic prescribing in the primary care sector. We aimed to identify practice-related factors associated with high prescribers, including prescribers of critically important antibiotics as defined by WHO, after accounting for case mix by practice.
We performed a nationwide register-based survey of antibiotic prescribing in Danish general practice from 2012 to 2013. The unit of analysis was the individual practice. We used multivariable regression analyses and an assessment of relative importance to identify practice-related factors driving high antibiotic prescribing rates.
We included 98% of general practices in Denmark ( n = 1962) and identified a 10% group of high prescribers who accounted for 15% of total antibiotic prescriptions and 18% of critically important antibiotic prescriptions. Once case mix had been accounted for, the following practice-related factors were associated with being a high prescriber: lack of access to diagnostic tests in practice (C-reactive protein and urine culture); high use of diagnostic tests (urine culture and strep A throat test); a low percentage of antibiotic prescriptions issued over the phone compared with all antibiotic prescriptions; and a high number of consultations per 1000 patients. We also found that a low number of consultations per 1000 patients was associated with a reduced likelihood of being a high prescriber of antibiotics.
An apparent underuse or overuse of diagnostic tests in general practice as well as organizational factors were associated with high-prescribing practices. Furthermore, the choice of antibiotic type seemed less rational among high prescribers.
在丹麦，初级医疗部门75%的抗生素处方由全科医疗负责。我们旨在确定与高处方量医生相关的执业相关因素，包括世界卫生组织定义的 critically important antibiotics 的处方医生，同时考虑各诊所的病例组合情况。
我们对2012年至2013年丹麦全科医疗中的抗生素处方进行了一项基于全国登记的调查。分析单位是个体诊所。我们使用多变量回归分析和相对重要性评估来确定导致抗生素高处方率的执业相关因素。
我们纳入了丹麦98%的全科医疗诊所（n = 1962），并确定了一个占比10%的高处方量医生群体，他们占抗生素处方总量的15%，以及 critically important antibiotics 处方的18%。在考虑病例组合情况后，以下执业相关因素与成为高处方量医生有关：诊所无法进行诊断检测（C反应蛋白和尿培养）；诊断检测使用频繁（尿培养和A组链球菌咽喉检测）；与所有抗生素处方相比，通过电话开具的抗生素处方比例较低；以及每1000名患者的会诊次数较多。我们还发现，每1000名患者的会诊次数较少与成为抗生素高处方量医生的可能性降低有关。
全科医疗中诊断检测明显使用不足或过度以及组织因素与高处方量行为有关。此外，高处方量医生在抗生素类型的选择上似乎不太合理。
