Molero José M, Moragas Ana, González López-Valcárcel Beatriz, Bjerrum Lars, Cots Josep M, Llor Carl
San Andrés Primary Health Centre, Department Preventive Medicine, University Rey Juan Carlos, Madrid, Spain.
Jaume I Health Centre, University Rovira i Virgili, Tarragona, Spain.
Int J Clin Pract. 2019 May;73(5):e13312. doi: 10.1111/ijcp.13312. Epub 2019 Feb 6.
Few studies have evaluated the long-term impact of interventions on antibiotic prescription for lower respiratory tract infections (LRTI). This study was aimed at evaluating the use of antibiotics prescribed for LRTIs by general practitioners (GP) who underwent a multifaceted intervention carried out 6 years earlier.
General practitioners who had completed two registrations in 2008 and 2009 were again invited to participate in a third audit-based study in 2015. A multifaceted intervention was held 1-3 months before the second registration. A new group of GPs with no previous training on the rational use of antibiotics were also invited to participate and acted as controls. Multilevel logistic regression was performed considering the prescription of antibiotics as the dependent variable.
A total of 121 GPs of the 210 who underwent the intervention (57.6%) and 117 control GPs registered 4333 episodes of LRTIs. On adjustment for covariables, compared with the antibiotic prescription for LRTIs observed just after the intervention, antibiotic prescription slightly increased 6 years later among GPs who had undergone the intervention (OR 1.17, 95% CI 0.95-1.43), while control GPs prescribed significantly more antibiotics (OR 2.31, 95% CI 1.62-3.29). However, withholding antibiotic prescribing with C-reactive protein (CRP) values <10 mg/L was more frequently observed just after the intervention compared 6 years later (12.7% vs 32.2%; P < 0.01).
Antibiotic prescribing for LRTIs remains low 6 years after an intervention, although GPs are less confident to withhold antibiotic therapy in patients with low CRP levels.
很少有研究评估干预措施对下呼吸道感染（LRTI）抗生素处方的长期影响。本研究旨在评估6年前接受多方面干预的全科医生（GP）为LRTIs开具抗生素的情况。
2008年和2009年完成两次注册的全科医生于2015年再次被邀请参加第三次基于审核的研究。在第二次注册前1 - 3个月进行了多方面干预。还邀请了一组之前没有接受过抗生素合理使用培训的新全科医生参与并作为对照。以抗生素处方作为因变量进行多水平逻辑回归分析。
接受干预的210名全科医生中有121名（57.6%）以及117名对照全科医生记录了4333例LRTIs病例。在对协变量进行调整后，与干预刚结束后观察到的LRTIs抗生素处方相比，接受干预的全科医生6年后抗生素处方略有增加（比值比[OR]1.17，95%置信区间[CI]0.95 - 1.43），而对照全科医生开具的抗生素显著更多（OR 2.31，95% CI 1.62 - 3.29）。然而，与6年后相比，干预刚结束后更频繁地观察到C反应蛋白（CRP）值<10 mg/L时不使用抗生素处方的情况（12.7%对32.2%；P < 0.01）。
干预6年后，LRTIs的抗生素处方率仍然较低，尽管全科医生对CRP水平低的患者不使用抗生素治疗的信心降低。
