Dyar Oliver James, Yang Ding, Yin Jia, Sun Qiang, Stålsby Lundborg Cecilia
Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
School of Health Care Management, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
BMJ Open. 2020 Jun 1;10(6):e036703. doi: 10.1136/bmjopen-2019-036703.
To assess variation in antibiotic prescribing practices among village doctors in a rural region of Shandong province, China.
DESIGN, SETTING AND PARTICIPANTS: Almost all outpatient encounters at village clinics result in a prescription being issued. Prescriptions were collected over a 2.5-year period from 8 primary care village clinics staffed by 24 doctors located around a town in rural Shandong province. A target of 60 prescriptions per clinic per month was sampled from an average total of around 300. Prescriptions were analysed at both aggregate and individual-prescriber levels, with a focus on diagnoses of likely viral acute upper respiratory tract infections (AURIs), defined as International Classification of Diseases, 10th Revision codes J00 and J06.9.
Proportions of prescriptions for AURIs containing (1) at least one antibiotic, (2) multiple antibiotics, (3) at least one parenteral antibiotic; classes and agents of antibiotics prescribed.
In total, 14 471 prescriptions from 23 prescribers were ultimately included, of which 5833 (40.3%) contained at least 1 antibiotic. Nearly two-thirds 62.5% (3237/5177) of likely viral AURI prescriptions contained an antibiotic, accounting for 55.5% (3237/5833) of all antibiotic-containing prescriptions. For AURIs, there was wide variation at the individual level in antibiotic prescribing rates (33.1%-88.0%), as well multiple antibiotic prescribing rates (1.3%-60.2%) and parenteral antibiotic prescribing rates (3.2%-62.1%). Each village doctor prescribed between 11 and 21 unique agents for AURIs, including many broad-spectrum antibiotics. Doctors in the highest quartile for antibiotic prescribing rates for AURI also had higher antibiotic prescribing rates than doctors in the lowest quartile for potentially bacterial upper respiratory tract infections (pharyngitis, tonsillitis, laryngopharyngitis; 89.1% vs 72.4%, p=0.002).
All village doctors overused antibiotics for respiratory tract infections. Variations in individual prescriber practices are significant even in a small homogenous setting and should be accounted for when developing targets and interventions to improve antibiotic use.
评估中国山东省某农村地区乡村医生抗生素处方行为的差异。
设计、地点和参与者：几乎所有在乡村诊所的门诊就诊都会开具处方。在2.5年的时间里，从山东省农村一个镇周围由24名医生任职的8家基层乡村诊所收集处方。每家诊所每月从平均约300张处方中抽取60张作为样本。在总体和个体开方者层面分析处方，重点关注可能的病毒性急性上呼吸道感染（AURI）的诊断，定义为国际疾病分类第10版编码J00和J06.9。
AURI处方中包含（1）至少一种抗生素、（2）多种抗生素、（3）至少一种胃肠外抗生素的比例；所开抗生素的类别和药物。
最终纳入了来自23名开方者的14471张处方，其中5833张（40.3%）包含至少一种抗生素。近三分之二（62.5%，3237/5177）可能的病毒性AURI处方包含抗生素，占所有含抗生素处方的55.5%（3237/5833）。对于AURI，抗生素处方率（33.1%-88.0%）、多种抗生素处方率（1.3%-60.2%）和胃肠外抗生素处方率（3.2%-62.1%）在个体层面存在很大差异。每位乡村医生为AURI开具了11至21种不同的药物，包括许多广谱抗生素。AURI抗生素处方率处于最高四分位数的医生，其抗生素处方率也高于可能的细菌性上呼吸道感染（咽炎、扁桃体炎、喉咽炎）处方率处于最低四分位数的医生（89.1%对72.4%，p=0.002）。
所有乡村医生在呼吸道感染方面都过度使用了抗生素。即使在一个小的同质环境中，个体开方者行为的差异也很显著,在制定改善抗生素使用的目标和干预措施时应予以考虑。
