Institute of Health Informatics, University College London, London, NW1 2DA, UK.
Four Seasons Health Care, Norcliffe House, Station Road, Wilmslow, Cheshire, SK9 1BU, UK.
BMC Health Serv Res. 2020 Jun 18;20(1):555. doi: 10.1186/s12913-020-05422-z.
Older people living in care homes are particularly susceptible to infections and antibiotics are therefore used frequently for this population. However, there is limited information on antibiotic prescribing in this setting. This study aimed to investigate the frequency, patterns and risk factors for antibiotic prescribing in a large chain of UK care homes.
Retrospective cohort study of administrative data from a large chain of UK care homes (resident and care home-level) linked to individual-level pharmacy data. Residents aged 65 years or older between 1 January 2016 and 31 December 2017 were included. Antibiotics were classified by type and as new or repeated prescriptions. Rates of antibiotic prescribing were calculated and modelled using multilevel negative binomial regression.
13,487 residents of 135 homes were included. The median age was 85; 63% residents were female. 28,689 antibiotic prescriptions were dispensed, the majority were penicillins (11,327, 39%), sulfonamides and trimethoprim (5818, 20%), or other antibacterials (4665, 16%). 8433 (30%) were repeat prescriptions. The crude rate of antibiotic prescriptions was 2.68 per resident year (95% confidence interval (CI) 2.64-2.71). Increased antibiotic prescribing was associated with residents requiring more medical assistance (adjusted incidence rate ratio for nursing opposed to residential care 1.21, 95% CI 1.13-1.30). Prescribing rates varied widely by care home but there were no significant associations with the care home-level characteristics available in routine data.
Rates of antibiotic prescribing in care homes are high and there is substantial variation between homes. Further research is needed to understand the drivers of this variation to enable development of effective stewardship approaches that target the influences of prescribing.
居住在养老院的老年人特别容易感染，因此经常为这一人群使用抗生素。然而，关于该环境下抗生素处方的信息有限。本研究旨在调查英国一家大型养老院连锁店中抗生素处方的频率、模式和危险因素。
对一家英国大型养老院连锁店（居民和养老院级别）的行政数据进行回顾性队列研究，并与个人级别的药房数据相关联。纳入 2016 年 1 月 1 日至 2017 年 12 月 31 日期间年龄在 65 岁或以上的居民。根据类型和新处方或重复处方对抗生素进行分类。使用多水平负二项回归模型计算和模拟抗生素处方率。
共纳入 135 家养老院的 13487 名居民，中位年龄为 85 岁，63%的居民为女性。共开出 28689 张抗生素处方，其中大部分为青霉素（11327 张，39%）、磺胺类药物和甲氧苄啶（5818 张，20%）或其他抗菌药物（4665 张，16%）。8433 张（30%）为重复处方。抗生素处方的粗率为每居民年 2.68 次（95%置信区间[CI] 2.64-2.71）。需要更多医疗协助的居民抗生素处方率更高（护理与居住护理相比的调整发病率比为 1.21，95%CI 1.13-1.30）。各养老院的处方率差异很大，但与常规数据中可用的养老院水平特征无显著关联。
养老院的抗生素处方率很高，且各养老院之间存在很大差异。需要进一步研究以了解这种差异的驱动因素，从而制定针对处方影响的有效管理方法。
