2010-2014 年英格兰非工作时间初级保健提供者中抗生素处方的趋势和模式。
Trends and patterns in antibiotic prescribing among out-of-hours primary care providers in England, 2010-14.
机构信息
Antimicrobial Resistance Programme, Public Health England, 133-155 Waterloo Rd, Lambeth, London SE1 8UG, UK.
出版信息
J Antimicrob Chemother. 2017 Dec 1;72(12):3490-3495. doi: 10.1093/jac/dkx323.
OBJECTIVES
Antimicrobial resistance is a global threat, increasing morbidity and mortality. In England, publicly funded clinical commissioning groups (CCGs) commission out-of-hours (OOH) primary care services outside daytime hours. OOH consultations represent 1% of in-hours general practice (GP) consultations. Antibiotic prescriptions increased 32% in non-GP community services between 2010 and 2013. We describe OOH antibiotic prescribing patterns and trends between 2010 and 2014.
METHODS
We: estimated the proportion of CCGs with OOH data available; described and compared antibiotic prescribing by volume of prescribed items, seasonality and trends in GP and OOH, using linear regression; and compared the proportion of broad-spectrum to total antibiotic prescriptions in OOHs with their respective CCGs in terms of seasonality and trends, using binomial regression.
RESULTS
Data were available for 143 of 211 (68%) CCGs. OOH antibiotic prescription volume represented 4.5%-5.4% of GP prescription volume and was stable over time (P = 0.37). The proportion of broad-spectrum antibiotic prescriptions increased in OOH when it increased in the CCG they operated in (regression coefficient 0.98; 95% CI 0.96-0.99). Compared with GP, the proportion of broad-spectrum antibiotic prescriptions in OOH was higher but decreased both in GP and OOH (-0.57%, 95% CI - 0.54% to - 0.6% and -0.76%, 95% CI - 0.59% to - 0.93% per year, respectively).
CONCLUSIONS
OOH proportionally prescribed more antibiotics than GPs although we could not comment on prescribing appropriateness. OOH prescribing volume was stable over time, and followed GP seasonal patterns. OOH antibiotic prescribing reflected the CCGs they operated in but with relatively more broad-spectrum antibiotics than in-hours GP. Understanding factors influencing prescribing in OOH will enable the development of tailored interventions promoting optimal prescribing in this setting.
目的
抗菌药物耐药性是一个全球性威胁，会增加发病率和死亡率。在英国，由公共资金资助的临床委托组（CCG）在非工作时间（OOH）为日间医疗服务提供补充。OOH 咨询占非工作时间普通科医生（GP）咨询的 1%。2010 年至 2013 年期间，非 GP 社区服务中的抗生素处方增加了 32%。我们描述了 2010 年至 2014 年 OOH 抗生素处方模式和趋势。
方法
我们：估计了有 OOH 数据的 CCG 比例；描述和比较了按规定项目数量的体积、季节性和 GP 和 OOH 之间的趋势，使用线性回归；并比较了 OOH 中广谱抗生素处方与相应 CCG 之间的比例，使用二项式回归比较了季节性和趋势。
结果
在 211 个 CCG 中有 143 个（68%）提供了数据。OOH 抗生素处方量占 GP 处方量的 4.5%-5.4%，且随时间保持稳定（P=0.37）。当 OOH 所在的 CCG 增加广谱抗生素处方时，OOH 中的广谱抗生素处方比例增加（回归系数 0.98；95%置信区间 0.96-0.99）。与 GP 相比，OOH 中广谱抗生素处方的比例更高，但 GP 和 OOH 均呈下降趋势（分别为-0.57%，95%置信区间-0.54%至-0.6%和-0.76%，95%置信区间-0.59%至-0.93%/年）。
结论
OOH 相对 GP 处方的抗生素比例更高，尽管我们无法评论处方的适当性。OOH 处方量随时间保持稳定，且遵循 GP 的季节性模式。OOH 抗生素处方反映了它们所在的 CCG，但与日间 GP 相比，广谱抗生素的比例相对较高。了解影响 OOH 处方的因素将有助于制定针对该环境的优化处方干预措施。
Zotero 插件