Thomas Mark, Tomlin Andrew, Duffy Eamon, Tilyard Murray
Associate Professor, Department of Molecular Medicine and Pathology, University of Auckland, Auckland; Adult Infectious Diseases Department, Auckland City Hospital, Auckland.
Research Consultant, Best Practice Advocacy Centre, Dunedin.
N Z Med J. 2020 Jul 17;133(1518):33-42.
The overall rate of community antibiotic dispensing in New Zealand in recent decades has been high when compared with many other nations, but since 2015 has consistently declined each year. We aimed to determine whether the magnitude of reductions in community antibiotic dispensing in New Zealand between 2015 and 2018 differed in relation either to the patient's demographic features or in relation to the primary health organisation of the patient's registered general practitioner.
Demographic data on all patients registered with a general practice in New Zealand, and on all community pharmacy antibiotic dispensing for these patients during 2013-2018 were obtained from national healthcare databases. The rates of dispensing for patients registered with a general practitioner were measured as antibiotic courses dispensed per 1,000 population per day, and as defined daily doses per 1,000 population per day.
Total community antibiotic dispensing in New Zealand, measured as defined daily doses per 1,000 inhabitants per day, decreased by 13.8% during 2015-2018, an average annual reduction of 4.6% per year, with especially large reductions in dispensing of amoxicillin/clavulanate, fluoroquinolones and macrolides. The reductions in dispensing were greatest in children aged 0-4 years old, but lesser reductions were seen in all age groups. Antibiotic dispensing declined regardless of patient ethnicity or level of socioeconomic deprivation. There were marked differences between primary health organisations in the size of the reductions in antibiotic dispensing during 2015-2018, which ranged between 4.8% for the Te Tai Tokerau PHO to 21.5% for the Ngati Porou Hauora Charitable Trust PHO.
Total community antibiotic dispensing has reduced significantly in New Zealand between 2015 and 2018, with large disparities between primary health organisations in the size of the reductions. The overall rates of antibiotic dispensing remain high for non-Māori and non-Pacific people, and prescribers should aim to further reduce inappropriate antibiotic prescribing for these populations. However, the overall rate of antibiotic dispensing for Māori and Pacific people may now approximate an optimal level. Prescribers should aim to further reduce inappropriate antibiotic prescribing, but also to increase appropriate antibiotic prescribing for these populations.
与许多其他国家相比，新西兰近几十年来社区抗生素配药的总体比例一直较高，但自2015年以来每年持续下降。我们旨在确定2015年至2018年新西兰社区抗生素配药减少的幅度是否因患者的人口统计学特征或患者注册全科医生所在的初级卫生组织而异。
从国家医疗保健数据库中获取了新西兰所有在全科诊所注册患者的人口统计数据，以及这些患者在2013 - 2018年期间社区药房所有抗生素配药的数据。以每千人口每天配药的抗生素疗程数以及每千人口每天的限定日剂量来衡量全科医生注册患者的配药率。
以每千居民每天的限定日剂量衡量，新西兰社区抗生素总配药量在2015年至2018年期间下降了13.8%，平均每年下降4.6%，阿莫西林/克拉维酸、氟喹诺酮类和大环内酯类药物的配药量下降尤为显著。0至4岁儿童的配药量下降幅度最大，但所有年龄组的下降幅度都较小。无论患者种族或社会经济剥夺程度如何，抗生素配药量均下降。2015年至2018年期间，各初级卫生组织在抗生素配药量减少幅度方面存在显著差异，从泰伊托克劳初级卫生组织的4.8%到恩加蒂波罗乌奥拉慈善信托初级卫生组织的21.5%不等。
2015年至2018年期间，新西兰社区抗生素总配药量显著减少，各初级卫生组织在减少幅度上存在很大差异。非毛利人和非太平洋岛民的抗生素总体配药率仍然很高，开处方者应致力于进一步减少这些人群不适当的抗生素处方。然而，毛利人和太平洋岛民的抗生素总体配药率现在可能接近最佳水平。开处方者应致力于进一步减少不适当的抗生素处方，同时也应增加这些人群适当的抗生素处方。
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