Fischer Michael A, Mahesri Mufaddal, Lii Joyce, Linder Jeffrey A
Michael A. Fischer ( mfischer@partners. org ) is an associate professor of medicine at Harvard Medical School and an associate physician in the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, both in Boston, Massachusetts.
Mufaddal Mahesri is a research specialist in the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital.
Health Aff (Millwood). 2020 Feb;39(2):280-288. doi: 10.1377/hlthaff.2019.00545.
Ambulatory antibiotic stewardship policies focus on prescribing decisions made when patients present to clinicians with possible infections. They do not capture antibiotics prescribed outside of clinician visits or without clear indications for use. Antibiotic prescribing for vulnerable patients in the US has not been comprehensively measured. We measured the frequency with which all filled antibiotic prescriptions were associated with infections and in-person visits for Medicaid patients in the period 2004-13. We found that among 298 million antibiotic fills (62 percent for children) for 53 million patients, 55 percent were for clinician visits with an infection-related diagnosis, 17 percent were for clinician visits without an infection-related diagnosis, and 28 percent were not associated with a visit. Non-visit-based antibiotic prescriptions were less common for children than for adults and more common in the West than in other US regions. Large fractions of antibiotic prescriptions are filled without evidence of infection-related diagnoses or accompanying clinician visits. Current ambulatory antibiotic stewardship policies miss about half of antibiotic prescribing.
门诊抗生素管理政策关注的是患者因可能感染而就诊时临床医生所做出的处方决定。这些政策并未涵盖在非临床就诊时开具的抗生素处方，或无明确使用指征的抗生素处方。美国针对弱势患者的抗生素处方情况尚未得到全面衡量。我们统计了2004年至2013年期间医疗补助患者所有已配药的抗生素处方与感染及门诊就诊相关的频率。我们发现，在为5300万患者开具的2.98亿份抗生素处方中（62%为儿童处方），55%是针对有感染相关诊断的门诊就诊，17%是针对无感染相关诊断的门诊就诊，28%与门诊就诊无关。基于非门诊的抗生素处方在儿童中比在成人中少见，在美国西部比在其他地区更常见。很大一部分抗生素处方是在没有感染相关诊断证据或没有临床医生陪同就诊的情况下开具的。当前的门诊抗生素管理政策遗漏了约一半的抗生素处方。
