Preventive Medicine Service, Santiago de Compostela University Teaching Hospital, Santiago de Compostela, Spain.
Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain.
PLoS One. 2019 Aug 22;14(8):e0221326. doi: 10.1371/journal.pone.0221326. eCollection 2019.
To assess the impact of sources of drug information on antibiotic prescribing patterns (quantity and quality) among primary care physicians.
We conducted a cohort study on primary care physicians who were actively engaged in medical practice in 2010 in a region in north-west Spain (Galicia), fulfilling inclusion criteria (n = 2100). As the independent variable, we took the perceived utility of 6 sources of information on antibiotics, as measured by the validated KAAR-11 questionnaire. As dependent variables, we used: (1) a quality indicator (appropriate quality, defined as any case where 6 of the 12 indicators proposed by the European Surveillance of Antimicrobial Consumption Network [ESAC-Net] were better than the mean values for Spain); and, (2) a quantity indicator (high prescribing), defined as any case where defined daily doses (DDD) per 1 000 inhabitants per day of antibacterials for systemic use were higher than the mean values for Spain. The adjusted odds ratio for a change in the interquartile range (IqOR) for each sources of information on antibiotics was calculated using Generalized Linear Mixed Models.
The questionnaire response rate was 68%. Greater perceived utility of pharmaceutical sales representatives increases the risk of having high prescribing (1/IqOR = 2.50 [95%CI: 1.63-3.66]) and reduces the probability of having appropriate quality (1/IqOR = 2.28 [95%CI: 1.77-3.01]). Greater perceived utility of clinical guidelines increases the probability of having appropriate quality (1/IqOR = 1.25 [95%CI: 1.02-1.54]) and reduces the probability of high prescribing (1/IqOR = 1.25 [95%CI: 1.02-1.54]).
Sources of information on antibiotics are an important determinant of the quantity and quality of antibiotic prescribing in primary care. Commercial sources of information influence prescribing negatively, and clinical guidelines are associated with better indicators.
评估药物信息来源对初级保健医生抗生素处方模式（数量和质量）的影响。
我们对 2010 年在西班牙西北部加利西亚地区积极从事医疗实践的初级保健医生进行了队列研究，符合纳入标准（n=2100）。作为自变量，我们采用经过验证的 KAAR-11 问卷衡量了对 6 种抗生素信息来源的感知效用。作为因变量，我们使用了：（1）质量指标（适当质量，定义为任何情况下，欧洲抗菌药物消耗监测网络[ESAC-Net]提出的 12 个指标中有 6 个优于西班牙的平均值）；（2）数量指标（高处方），定义为任何情况下，用于全身使用的抗菌药物的每 1000 居民日定义日剂量（DDD）高于西班牙的平均值。使用广义线性混合模型计算抗生素信息来源每四分位距（IqOR）变化的调整比值比（1/IqOR）。
问卷回复率为 68%。销售人员的感知效用越大，高处方的风险就越高（1/IqOR=2.50[95%CI：1.63-3.66]），适当质量的可能性就越低（1/IqOR=2.28[95%CI：1.77-3.01]）。临床指南的感知效用越大，适当质量的可能性就越高（1/IqOR=1.25[95%CI：1.02-1.54]），高处方的可能性就越低（1/IqOR=1.25[95%CI：1.02-1.54]）。
抗生素信息来源是初级保健抗生素处方数量和质量的重要决定因素。商业信息来源对处方有负面影响，而临床指南与更好的指标相关。
