Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand.
Institute for Innovation and Improvement, Waitematā District Health Board, Auckland, New Zealand.
PLoS One. 2019 Jul 17;14(7):e0219818. doi: 10.1371/journal.pone.0219818. eCollection 2019.
The literature regarding diverticular disease of the intestines (DDI) almost entirely concerns hospital-based care; DDI managed in primary care settings is rarely addressed.
To estimate how often DDI is managed in primary care, using antibiotics dispensing data.
Hospitalisation records of New Zealand residents aged 30+ years during 2007-2016 were individually linked to databases of community-dispensed oral antibiotics.
Patients with an index hospital admission 2007-2016 including a DDI diagnosis (ICD-10-AM = K57) were grouped by acute/non-acute hospitalisation. We compared use of guideline-recommended oral antibiotics for the period 2007-2016 for these people with ten individually-matched non-DDI residents, taking the case's index date. Multivariable negative binomial models were used to estimate rates of antibiotic use.
From almost 3.5 million eligible residents, data were extracted for 51,059 index cases (20,880 acute, 30,179 non-acute) and 510,581 matched controls; mean follow-up = 8.9 years. Dispensing rates rose gradually over time among controls, from 47 per 100 person-years (/100py) prior to the index date, to 60/100py after 3 months. In comparison, dispensing was significantly higher for those with DDI: for those with acute DDI, rates were 84/100py prior to the index date, 325/100py near the index date, and 141/100py after 3 months, while for those with non-acute DDI 75/100py, 108/100py and 99/100py respectively. Following an acute DDI admission, community-dispensed antibiotics were dispensed at more than twice the rate of their non-DDI counterparts for years, and were elevated even before the index DDI hospitalisation.
DDI patients experience high use of antibiotics. Evidence is needed that covers primary-care and informs self-management of recurrent, chronic or persistent DDI.
关于肠憩室疾病（DDI）的文献几乎全部涉及医院为基础的护理；在初级保健环境中管理的 DDI 很少被涉及。
使用抗生素配药数据估计在初级保健中管理 DDI 的频率。
2007-2016 年期间，对新西兰 30 岁以上居民的住院记录进行了个体链接，链接到社区配药的口服抗生素数据库。
2007-2016 年期间，对索引住院患者进行了 DDI 诊断（ICD-10-AM=K57）的分组，急性/非急性住院。我们将这部分人群与 10 名未患 DDI 的个体匹配居民进行比较，比较了 2007-2016 年期间指南推荐的口服抗生素的使用情况，以患者的索引日期为准。使用多变量负二项式模型来估计抗生素的使用率。
从近 350 万符合条件的居民中，提取了 51059 例索引病例（20880 例急性，30179 例非急性）和 510581 例匹配对照者的数据；平均随访时间为 8.9 年。在对照者中，配药率随着时间的推移逐渐升高，从索引日期前的 47/100 人年（/100py）增加到 3 个月后的 60/100py。相比之下，患有 DDI 的患者的配药率明显更高：患有急性 DDI 的患者，在索引日期前的配药率为 84/100py，在索引日期附近为 325/100py，在 3 个月后为 141/100py，而患有非急性 DDI 的患者分别为 75/100py、108/100py 和 99/100py。在急性 DDI 入院后，社区配药的抗生素使用频率在数年内是其非 DDI 患者的两倍多，甚至在 DDI 住院之前就已经升高。
DDI 患者经历了高抗生素使用率。需要有证据涵盖初级保健，并为复发性、慢性或持续性 DDI 的自我管理提供信息。
