直接面向消费者的远程医疗中急性呼吸道感染的皮质类固醇使用。

Corticosteroid Use for Acute Respiratory Tract Infections in Direct-to-Consumer Telemedicine.

机构信息

Ochsner Health System, Jefferson Parish, Louisiana.

Center for Value-Based Care Research, Cleveland Clinic, Ohio.

出版信息

Am J Med. 2020 Aug;133(8):e399-e405. doi: 10.1016/j.amjmed.2020.02.014. Epub 2020 Mar 5.

DOI:10.1016/j.amjmed.2020.02.014

PMID:32147448

Abstract

BACKGROUND

Systemic corticosteroids are not indicated for acute respiratory tract infections yet are nonetheless prescribed in outpatient care. Acute respiratory tract infections are the most common diagnosis in direct-to-consumer telemedicine. The objective of this study was to characterize use of corticosteroids for acute respiratory tract infections in this setting and to assess the association between corticosteroid receipt and patient satisfaction.

METHODS

Encounters with acute respiratory tract infection patients 18 years and older on a nationwide direct-to-consumer telemedicine platform were conducted by physicians between July 2016 and July 2018. Mixed-effects logistic regression was used to assess differences in the odds of corticosteroid prescription. A second mixed-effects model assessed differences in patient satisfaction by corticosteroid or antibiotic receipt. Adjusted prescribing rates for individual physicians were estimated. Models included diagnoses, patient age and geographic region, physician specialty and geographic region, and antibiotic prescription.

RESULTS

Of the 85,972 encounters with 465 physicians, 11% resulted in the physician prescribing corticosteroids. The median physician prescribing rate was 4.0% (range: <1%-81%). Corticosteroid receipt was associated with higher satisfaction versus receiving nothing (odds ratio: 2.54; 95% confidence interval: 2.25-2.87). Patients who received both an antibiotic and a corticosteroid reported the highest satisfaction (odd ratio: 3.91; 95% confidence interval: 3.27-4.68). There was no correlation between individual physicians' corticosteroid and antibiotic prescribing rates.

CONCLUSIONS

Corticosteroid receipt was associated with patient satisfaction. Most physicians rarely prescribed corticosteroids, yet a small number prescribed them frequently. Identification of high-prescribing physicians for educational interventions could reduce use of corticosteroids for acute respiratory tract infections.

摘要

背景

全身用皮质类固醇不适用于急性呼吸道感染，但在门诊治疗中仍有开具。急性呼吸道感染是直接面向消费者的远程医疗中最常见的诊断。本研究的目的是描述在这种情况下急性呼吸道感染中皮质类固醇的使用情况，并评估皮质类固醇的使用与患者满意度之间的关系。

方法

在 2016 年 7 月至 2018 年 7 月期间，医生对全国范围内直接面向消费者的远程医疗平台上的急性呼吸道感染患者进行了调查。采用混合效应逻辑回归评估皮质类固醇处方的几率差异。采用第二个混合效应模型评估皮质类固醇或抗生素使用对患者满意度的差异。估计了个别医生的调整后处方率。模型包括诊断、患者年龄和地理位置、医生专业和地理位置以及抗生素处方。

结果

在 85972 次与 465 名医生的接触中，11%的患者被医生开了皮质类固醇。中位医生处方率为 4.0%（范围：<1%-81%）。与未接受治疗相比，接受皮质类固醇治疗与更高的满意度相关（优势比：2.54；95%置信区间：2.25-2.87）。同时接受抗生素和皮质类固醇治疗的患者报告的满意度最高（比值比：3.91；95%置信区间：3.27-4.68）。个别医生的皮质类固醇和抗生素处方率之间没有相关性。