急诊科中病毒感染性疾病抗生素使用的种族和民族差异。
Racial and Ethnic Differences in Antibiotic Use for Viral Illness in Emergency Departments.
作者信息
Goyal Monika K, Johnson Tiffani J, Chamberlain James M, Casper T Charles, Simmons Timothy, Alessandrini Evaline A, Bajaj Lalit, Grundmeier Robert W, Gerber Jeffrey S, Lorch Scott A, Alpern Elizabeth R
机构信息
Pediatrics and Emergency Medicine, Children's National Health System, The George Washington University, Washington, DC;
Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania.
出版信息
Pediatrics. 2017 Oct;140(4). doi: 10.1542/peds.2017-0203. Epub 2017 Sep 5.
BACKGROUND AND OBJECTIVES
In the primary care setting, there are racial and ethnic differences in antibiotic prescribing for acute respiratory tract infections (ARTIs). Viral ARTIs are commonly diagnosed in the pediatric emergency department (PED), in which racial and ethnic differences in antibiotic prescribing have not been previously reported. We sought to investigate whether patient race and ethnicity was associated with differences in antibiotic prescribing for viral ARTIs in the PED.
METHODS
This is a retrospective cohort study of encounters at 7 PEDs in 2013, in which we used electronic health data from the Pediatric Emergency Care Applied Research Network Registry. Multivariable logistic regression was used to examine the association between patient race and ethnicity and antibiotics administered or prescribed among children discharged from the hospital with viral ARTI. Children with bacterial codiagnoses, chronic disease, or who were immunocompromised were excluded. Covariates included age, sex, insurance, triage level, provider type, emergency department type, and emergency department site.
RESULTS
Of 39 445 PED encounters for viral ARTIs that met inclusion criteria, 2.6% (95% confidence interval [CI] 2.4%-2.8%) received antibiotics, including 4.3% of non-Hispanic (NH) white, 1.9% of NH black, 2.6% of Hispanic, and 2.9% of other NH children. In multivariable analyses, NH black (adjusted odds ratio [aOR] 0.44; CI 0.36-0.53), Hispanic (aOR 0.65; CI 0.53-0.81), and other NH (aOR 0.68; CI 0.52-0.87) children remained less likely to receive antibiotics for viral ARTIs.
CONCLUSIONS
Compared with NH white children, NH black and Hispanic children were less likely to receive antibiotics for viral ARTIs in the PED. Future research should seek to understand why racial and ethnic differences in overprescribing exist, including parental expectations, provider perceptions of parental expectations, and implicit provider bias.
背景与目的
在初级医疗环境中，急性呼吸道感染（ARTIs）的抗生素处方存在种族和民族差异。病毒感染性ARTIs在儿科急诊科（PED）中很常见，此前尚未报道过该科室在抗生素处方方面存在种族和民族差异。我们试图调查患者的种族和民族是否与PED中病毒感染性ARTIs的抗生素处方差异有关。
方法
这是一项对2013年7个PED科室就诊情况的回顾性队列研究，我们使用了儿科急诊护理应用研究网络登记处的电子健康数据。多变量逻辑回归用于检验患者的种族和民族与因病毒感染性ARTIs出院的儿童接受或开具抗生素之间的关联。排除患有细菌性合并诊断、慢性病或免疫功能低下的儿童。协变量包括年龄、性别、保险、分诊级别、医疗服务提供者类型、急诊科类型和急诊科地点。
结果
在39445例符合纳入标准的病毒感染性ARTIs的PED就诊病例中，2.6%（95%置信区间[CI]2.4%-2.8%）接受了抗生素治疗，其中非西班牙裔（NH）白人儿童为4.3%，NH黑人儿童为1.9%，西班牙裔儿童为2.6%，其他NH儿童为2.9%。在多变量分析中，NH黑人儿童（调整优势比[aOR]0.44；CI 0.36-0.53）、西班牙裔儿童（aOR 0.65；CI 0.53-0.81）和其他NH儿童（aOR 0.68；CI 0.52-0.87）因病毒感染性ARTIs接受抗生素治疗的可能性仍然较低。
结论
与NH白人儿童相比，NH黑人和西班牙裔儿童在PED中因病毒感染性ARTIs接受抗生素治疗的可能性较小。未来的研究应试图了解过度处方中存在种族和民族差异的原因，包括父母的期望、医疗服务提供者对父母期望的认知以及医疗服务提供者的隐性偏见。
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