Lindberg Bent H, Gjelstad Svein, Foshaug Mats, Høye Sigurd
a Hamar Out-of-hours Primary Care Centre , Hamar , Norway.
b Department of General Practice , Institute of Health and Society, University of Oslo , Hamar , Norway.
Scand J Prim Health Care. 2017 Jun;35(2):178-185. doi: 10.1080/02813432.2017.1333301. Epub 2017 Jun 1.
To examine factors correlating with antibiotic prescribing for acute respiratory tract infections (ARTIs) in Norwegian primary care out-of-hours service.
Retrospective data analysis for the year 2014 in two out-of-hours primary care units located in the towns of Hamar and Tønsberg in Norway, analysing type and frequency of different antibiotics prescribed by 117 medical doctors for ARTIs, and factors correlating with these.
The 117 doctors in two out-of-hours units diagnosed 6757 cases of ARTIs. 2310 (34.2%) of these resulted in an antibiotic prescription, where of 1615 (69.9%) were penicillin V (PcV). Tonsillitis and sinusitis were the two ARTI diagnoses with the highest antibiotic prescription rate. The antibiotic prescription rate increased successively with increasing activity level, measured as shorter median duration of consultations per session, from 28.7% (reference) in the least busy quintile of sessions to 36.6% (OR: 1.38 (95% CI =1.06-1.80)) in the busiest quintile of sessions. Prescribing of broad-spectrum antibiotics was not correlated with median duration of consultations per session. Female doctors had an OR of 0.61 (0.40-0.92) of a broad-spectrum antibiotic prescription compared to their male colleagues.
Antibiotic prescribing for ARTIs in the primary care out-of-hours services investigated is at the same level as in Norwegian general practice, but with a higher prescription rate of PcV. Antibiotic prescribing increases on busy sessions, measured as median duration of consultations per session. The work frame in primary care out-of-hours service might influence the quality of clinical decisions.
研究挪威初级医疗非工作时间服务中与急性呼吸道感染（ARTIs）抗生素处方相关的因素。
对位于挪威哈马尔和滕斯贝格镇的两个初级医疗非工作时间单位2014年的数据进行回顾性分析，分析117名医生针对ARTIs所开不同抗生素的类型和频率，以及与之相关的因素。
两个非工作时间单位的117名医生诊断出6757例ARTIs。其中2310例（34.2%）开具了抗生素处方，其中1615例（69.9%）为青霉素V（PcV）。扁桃体炎和鼻窦炎是抗生素处方率最高的两种ARTIs诊断。抗生素处方率随着活动水平的提高而依次增加，活动水平以每次会诊的中位数咨询时长衡量，从最不繁忙的五分之一时段的28.7%（参考值）增至最繁忙的五分之一时段的36.6%（比值比：1.38（95%可信区间=1.06 - 1.80））。广谱抗生素处方与每次会诊的中位数咨询时长无关。与男同事相比，女医生开具广谱抗生素处方的比值比为0.61（0.40 - 0.92）。
在所调查的初级医疗非工作时间服务中，ARTIs的抗生素处方情况与挪威全科医疗水平相当，但PcV的处方率更高。以每次会诊的中位数咨询时长衡量，繁忙时段的抗生素处方增加。初级医疗非工作时间服务的工作框架可能会影响临床决策的质量。
