通过以同行间整体抗生素使用率比较为中心的多方面干预措施改进退伍军人事务部初级保健系统中的抗生素处方
Improved Antibiotic Prescribing within a Veterans Affairs Primary Care System through a Multifaceted Intervention Centered on Peer Comparison of Overall Antibiotic Prescribing Rates.
机构信息
Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
Infectious Diseases Section, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.
出版信息
Antimicrob Agents Chemother. 2019 Dec 20;64(1). doi: 10.1128/AAC.00928-19.
Reducing inappropriate outpatient antibiotic use is an important national goal. Limited data exist on targeted education and peer comparison of overall antibiotic prescribing rates as an antimicrobial stewardship strategy. Primary care professionals (PCPs) from all seven clinics within our health care system were offered an education session, followed by monthly e-mails with their antibiotic prescribing rate, peer prescribing rates, and a system target. A pre-post analysis was conducted to compare prescribing rates during the intervention period (January to June 2017) to a seasonal baseline (January to June 2016) using a regression model. A random sample of prescriptions was reviewed for adherence to consensus guidelines. Educational sessions were attended by 68.5% (50/73) of PCPs. From the baseline to the intervention period, the mean rate of monthly antibiotic prescriptions declined from 76.9 to 49.5 per 1,000 office visits (35.6% reduction [ < 0.001]). Among reviewed cases, unnecessary antibiotic prescribing declined (58.8% [80/136] versus 38.9% [70/180]; 33.9% reduction [ = 0.0006]), and the rate of optimally prescribed antibiotics increased (19.9% [27/136] versus 30% [54/180]; 50.8% increase [ = 0.05]). If an antibiotic was indicated, there were no significant differences in prescribing of guideline-discordant agents (21.4% [12/56] versus 19.1% [21/110] [ = 0.8]) or guideline-concordant agents for a guideline-discordant duration (38.6% [17/44] versus 39.3% [35/89] [ = 1]). There were significant reductions in azithromycin and fluoroquinolone prescriptions (50.9% and 59.4% [ values of <0.001], respectively), but most prescriptions for these agents in the intervention period remained inappropriate. Initial education followed by monthly peer comparison of overall antibiotic prescribing rates reduced total and unnecessary antibiotic prescribing in primary care clinics.
减少不合理的门诊抗生素使用是一个重要的国家目标。针对整体抗生素处方率作为抗菌药物管理策略的靶向教育和同行比较，相关数据有限。我们医疗系统的所有 7 家诊所的基层医疗保健专业人员（PCP）都参加了一个教育课程，随后每月会收到电子邮件，内容包括他们的抗生素处方率、同行处方率和系统目标。采用回归模型对干预期（2017 年 1 月至 6 月）与季节性基线（2016 年 1 月至 6 月）的处方率进行了前后分析。随机抽取处方样本以评估其是否符合共识指南。有 68.5%（50/73）的 PCP 参加了教育课程。从基线到干预期，每月抗生素处方率从 76.9 下降至 49.5 次/千次就诊（减少 35.6% [ < 0.001]）。在所审查的病例中，不必要的抗生素处方减少（58.8% [80/136]与 38.9% [70/180]；减少 33.9% [ = 0.0006]），而最佳处方抗生素的比例增加（19.9% [27/136]与 30% [54/180]；增加 50.8% [ = 0.05]）。如果需要使用抗生素，则指南不一致的药物的处方率（21.4% [12/56]与 19.1% [21/110] [ = 0.8]）或指南不一致的药物的指南一致的疗程的处方率（38.6% [17/44]与 39.3% [35/89] [ = 1]）没有显著差异。阿奇霉素和氟喹诺酮类药物的处方明显减少（分别减少 50.9%和 59.4% [值均<0.001]），但干预期这些药物的大部分处方仍不合理。最初的教育，随后是每月对整体抗生素处方率的同行比较，减少了基层诊所的总抗生素和不必要的抗生素处方。
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