Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, and University of Basel, Basel, Switzerland.
Division of Infectious Diseases and Hospital Hygiene, University Hospital Basel, and University of Basel, Basel, Switzerland.
J Antimicrob Chemother. 2017 Nov 1;72(11):3205-3212. doi: 10.1093/jac/dkx278.
To assess the quality of antibiotic prescribing of Swiss primary care physicians with high prescription rates.
In January 2015, we mailed a structured questionnaire to 2900 primary care physicians in Switzerland. They were included in a nationwide pragmatic randomized controlled trial on routine antibiotic prescription monitoring and feedback based on health insurance claims data. We asked them to record the diagnosis and antibiotic treatment for 44 consecutive patients with the most common conditions associated with antibiotic prescribing in primary care. We evaluated if the disease-specific antibiotic prescribing and the proportion of non-recommended antibiotics used, in particular quinolones, were within 'acceptable ranges' using adapted European Surveillance of Antimicrobial Consumption (ESAC) quality indicators.
Two hundred and fifty physicians (8.6%) responded, providing 9961 patient records. Responders were similar to the entire physician population. Overall, antibiotics were prescribed to 32.1% of patients. For tonsillitis/pharyngitis, acute otitis media, acute rhinosinusitis and acute bronchitis the acceptable maximum of antibiotic prescriptions was exceeded by 24.4%, 49.6%, 27.4% and 11.5%, respectively. The proportion of non-recommended antibiotics was for all diagnoses above the recommended maximum of 20% (31.5%-88.7% across all conditions). Quinolones were prescribed to 37.2% of women with urinary tract infections, substantially exceeding the recommended maximum of 5%.
Antibiotic prescribing quality of Swiss primary care physicians with high prescription rates is low according to the indicators used, with substantial overtreatment of tonsillitis/pharyngitis, acute rhinosinusitis, acute otitis media and acute bronchitis. Routine nationwide and continuous monitoring of antibiotic use and specific interventions are warranted to improve prescribing in primary care.
评估瑞士高处方率初级保健医生抗生素处方的质量。
2015 年 1 月，我们向瑞士 2900 名初级保健医生邮寄了一份结构化问卷。他们被纳入一项基于健康保险索赔数据的常规抗生素处方监测和反馈的全国范围实用随机对照试验。我们要求他们记录 44 名最常见的与初级保健中抗生素处方相关的疾病患者的诊断和抗生素治疗情况。我们使用经过改编的欧洲抗生素消耗监测（ESAC）质量指标来评估特定疾病的抗生素处方和使用的非推荐抗生素（特别是喹诺酮类药物）的比例是否在“可接受范围”内。
250 名医生（8.6%）做出了回应，提供了 9961 名患者的记录。应答者与整个医生人群相似。总体而言，抗生素的处方率为 32.1%。对于扁桃体炎/咽炎、急性中耳炎、急性鼻-鼻窦炎和急性支气管炎，抗生素的处方率分别超过可接受的最大处方率 24.4%、49.6%、27.4%和 11.5%。所有诊断的非推荐抗生素的比例均高于推荐的最大比例 20%（所有情况下的比例为 31.5%-88.7%）。喹诺酮类药物被开给 37.2%的女性尿路感染患者，大大超过了推荐的最大比例 5%。
根据使用的指标，高处方率的瑞士初级保健医生的抗生素处方质量较低，扁桃体炎/咽炎、急性鼻-鼻窦炎、急性中耳炎和急性支气管炎的过度治疗情况明显。需要在全国范围内进行常规和持续的抗生素使用监测以及具体的干预措施，以改善初级保健中的处方。
