减少早期职业全科医生对呼吸道感染的抗生素处方：一项实用的前瞻性非随机对照试验。

Reducing early career general practitioners' antibiotic prescribing for respiratory tract infections: a pragmatic prospective non-randomised controlled trial.

作者信息

Magin Parker, Tapley Amanda, Morgan Simon, Davis Joshua S, McElduff Patrick, Yardley Lucy, Henderson Kim, Dallas Anthea, McArthur Lawrie, Mulquiney Katie, Davey Andrew, Little Paul, Spike Neil, van Driel Mieke L

机构信息

School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.

NSW & ACT Research and Evaluation Unit, GP Synergy Regional Training Organization, Newcastle, Australia.

出版信息

Fam Pract. 2018 Jan 16;35(1):53-60. doi: 10.1093/fampra/cmx070.

DOI:10.1093/fampra/cmx070

PMID:28985369

Abstract

BACKGROUND

Inappropriate antibiotic prescription and consequent antibacterial resistance is a major threat to healthcare.

OBJECTIVES

To evaluate the efficacy of a multifaceted intervention in reducing early career general practitioners' (GPs') antibiotic prescribing for upper respiratory tract infections (URTIs) and acute bronchitis/bronchiolitis.

METHODS

A pragmatic non-randomized trial employing a non-equivalent control group design nested within an existing cohort study of GP registrars' (trainees') clinical practice. The intervention included access to online modules (covering the rationale of current clinical guidelines recommending non-prescription of antibiotics for URTI and bronchitis/bronchiolitis, and communication skills in management of acute bronchitis) followed by a face-to-face educational session. The intervention was delivered to registrars (and their supervisors) in two of Australia's seventeen regional GP training providers (RTPs). Three other RTPs were the control group. Outcomes were proportion of registrars' URTI consultations and bronchitis/bronchiolitis consultations prescribed antibiotics. Intention-to-treat analyses employed logistic regression within a Generalised Estimating Equation framework, adjusted for relevant independent variables. The predictors of interest were time; treatment group; and an interaction term for time-by-treatment group. The P value associated with an interaction term determined statistically significant differences in antibiotic prescribing.

RESULTS

Analyses include data of 217 intervention RTPs' and 311 control RTPs' registrars. There was no significant reduction in antibiotic prescribing for URTIs. For bronchitis/bronchiolitis, a significant reduction (interaction P value = 0.024) remained true for analysis adjusted for independent variables (P value = 0.040). The adjusted absolute reduction in prescribing was 15.8% (95% CI: 4.2%-27.5%).

CONCLUSIONS

A multifaceted intervention reduced antibiotic prescribing for bronchitis/bronchiolitis but not URTIs.

摘要

背景

不恰当的抗生素处方及随之而来的抗菌药物耐药性是医疗保健面临的重大威胁。

目的

评估多方面干预措施在减少初入职场的全科医生（GP）对上呼吸道感染（URTI）和急性支气管炎/细支气管炎开具抗生素处方方面的效果。

方法

一项实用的非随机试验，采用不等同对照组设计，嵌套于一项现有的关于GP注册医师（实习生）临床实践的队列研究中。干预措施包括提供在线模块（涵盖当前临床指南中建议对URTI和支气管炎/细支气管炎不使用抗生素的原理，以及急性支气管炎管理中的沟通技巧），随后进行面对面的教育课程。干预措施在澳大利亚17个地区全科医生培训机构（RTP）中的两个机构提供给注册医师（及其上级医师）。另外三个RTP为对照组。结局指标是注册医师针对URTI会诊和支气管炎/细支气管炎会诊开具抗生素处方的比例。意向性分析在广义估计方程框架内采用逻辑回归，并对相关自变量进行校正。感兴趣的预测因素为时间；治疗组；以及时间与治疗组的交互项。与交互项相关的P值决定了抗生素处方的统计学显著差异。