Vanderbilt University Medical School, Nashville, TN, USA.
Department of Health Policy, Vanderbilt University, Nashville, TN, USA.
Fam Pract. 2020 Mar 25;37(2):180-186. doi: 10.1093/fampra/cmz049.
Antibiotic resistance is increasing, largely due to the overuse of antibiotics. Patient demographic characteristics can influence rates of antibiotic prescription, but less research has assessed the role of facility-level characteristics.
The objective of this study was to examine the prevalence of antibiotic prescriptions for viral-like illness, as well as patient and provider factors that influence antibiotic prescription practices.
We conducted an observational cohort study using data from the 2012 National Ambulatory Medical Care Survey. We compared the prevalence of antibiotic prescription for all aetiologies and for viral-like illnesses between community health centres, non-community health centre clinics and emergency departments. Then, we used logistic regression models to compare the odds of antibiotic prescription use by facility and patient characteristics.
Data came from 630 community health centre visits, 857 non-community health centre outpatient clinic visits and 627 emergency department visits. Compared to patients visiting non-community health centre clinics, patients visiting community health centres and emergency departments for any aetiology were more likely to receive antibiotic prescriptions. Patients with viral-like illnesses were less likely to receive antibiotics at community health centres and exhibited similar odds of receiving antibiotics at emergency departments. Certain patient demographics (age, race/ethnicity and payment source) were associated with variation in overall antibiotic prescription, but these factors were mostly unassociated with antibiotic prescription for viral-like illnesses.
The care setting that patients visit may influence their odds of receiving antibiotics. Initiatives addressing overuse of antibiotics should be mindful of facility- and patient-based characteristics when designing interventions.
抗生素耐药性日益增加，主要是由于抗生素的过度使用。患者人口统计学特征可能会影响抗生素处方率，但对医疗机构层面特征的研究较少。
本研究旨在检查病毒性疾病抗生素处方的流行情况，以及影响抗生素处方实践的患者和提供者因素。
我们使用 2012 年全国门诊医疗调查的数据进行了一项观察性队列研究。我们比较了社区卫生中心、非社区卫生中心诊所和急诊部门所有病因和病毒性疾病抗生素处方的流行率。然后，我们使用逻辑回归模型比较了医疗机构和患者特征与抗生素处方使用的几率。
数据来自 630 次社区卫生中心就诊、857 次非社区卫生中心门诊就诊和 627 次急诊就诊。与到非社区卫生中心诊所就诊的患者相比，因任何病因就诊于社区卫生中心和急诊部门的患者更有可能接受抗生素处方。在社区卫生中心，病毒性疾病患者接受抗生素治疗的可能性较小，在急诊部门接受抗生素治疗的可能性与病毒性疾病患者相似。某些患者人口统计学特征（年龄、种族/民族和支付来源）与抗生素总体处方的变化有关，但这些因素与病毒性疾病抗生素处方的关系不大。
患者就诊的医疗机构可能会影响他们接受抗生素治疗的几率。在设计干预措施时，解决抗生素过度使用的倡议应考虑医疗机构和患者的特征。
