Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA.
Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.
Clin Infect Dis. 2021 Oct 5;73(7):e1672-e1679. doi: 10.1093/cid/ciaa1173.
One underexplored driver of inappropriate antibiotic prescribing for acute respiratory illnesses (ARI) is patients' prior care experiences. When patients receive antibiotics for an ARI, patients may attribute their clinical improvement to the antibiotics, regardless of their true benefit. These experiences, and experiences of family members, may drive whether patients seek care or request antibiotics for subsequent ARIs.
Using encounter data from a national United States insurer, we identified patients <65 years old with an index ARI urgent care center (UCC) visit. We categorized clinicians within each UCC into quartiles based on their ARI antibiotic prescribing rate. Exploiting the quasi-random assignment of patients to a clinician within an UCC, we examined the association between the clinician's antibiotic prescribing rate to the patients' and their spouses' rates of ARI antibiotic receipt in the subsequent year.
Across 232,256 visits at 736 UCCs, ARI antibiotic prescribing rates were 42.1% and 80.2% in the lowest and highest quartile of clinicians, respectively. Patient characteristics were similar across the four quartiles. In the year after the index ARI visit, patients seen by the highest-prescribing clinicians received more ARI antibiotics (+3.0 fills/100 patients (a 14.6% difference), 95% CI 2.2-3.8, P < 0.001,) versus those seen by the lowest-prescribing clinicians. The increase in antibiotics was also observed among the patients' spouses. The increase in patient ARI antibiotic prescriptions was largely driven by an increased number of ARI visits (+5.6 ARI visits/100 patients, 95% CI 3.6-7.7, P < 0.001), rather than a higher antibiotic prescribing rate during those subsequent ARI visits.
Receipt of antibiotics for an ARI increases the likelihood that patients and their spouses will receive antibiotics for future ARIs.
导致急性呼吸道感染（ARI）不合理使用抗生素的一个未被充分探究的因素是患者之前的就医经历。当患者因 ARI 接受抗生素治疗时，无论抗生素是否真正有效，他们可能会将病情的改善归因于抗生素。这些经历以及患者家属的经历可能会影响患者是否会因后续的 ARI 寻求治疗或要求使用抗生素。
我们使用一家美国全国性保险公司的就诊数据，确定了年龄在 65 岁以下且患有 ARI 到急诊护理中心（UCC）就诊的患者。我们根据每位 UCC 医生开具抗生素治疗 ARI 的比率将医生分为四组。利用患者在 UCC 内随机分配给医生的情况，我们检查了医生开具抗生素的比率与患者及其配偶在次年接受 ARI 抗生素治疗的比率之间的关联。
在 736 家 UCC 的 232256 次就诊中，最低和最高四分位数医生开具 ARI 抗生素的比率分别为 42.1%和 80.2%。患者特征在四个四分位数之间相似。在索引 ARI 就诊后的一年中，由开处方比率最高的医生就诊的患者接受了更多的 ARI 抗生素（每 100 名患者增加 3.0 次就诊（14.6%的差异），95%CI2.2-3.8，P<0.001），而由开处方比率最低的医生就诊的患者则没有。患者配偶接受抗生素的数量也有所增加。患者 ARI 抗生素处方的增加主要是由于 ARI 就诊次数的增加（每 100 名患者增加 5.6 次就诊，95%CI3.6-7.7，P<0.001），而不是在随后的 ARI 就诊中抗生素的使用比率更高。
接受 ARI 抗生素治疗会增加患者及其配偶未来接受 ARI 抗生素治疗的可能性。
