The Hospital for Sick Children, Toronto, Ontario, Canada.
Public Health Ontario, Toronto, Ontario, Canada.
Clin Infect Dis. 2021 May 4;72(9):e345-e351. doi: 10.1093/cid/ciaa1139.
Approximately 25% of outpatient antibiotic prescriptions are unnecessary among family physicians in Canada. Minimizing unnecessary antibiotics is key for community antibiotic stewardship. However, unnecessary antibiotic prescribing is much harder to measure than total antibiotic prescribing. We investigated the association between total and unnecessary antibiotic use by family physicians and evaluated inter-physician variability in unnecessary antibiotic prescribing.
This was a cohort study based on electronic medical records of family physicians in Ontario, Canada, between April 2011 and March 2016. We used predefined expected antibiotic prescribing rates for 23 common primary care conditions to calculate unnecessary antibiotic prescribing rates. We used multilevel Poisson regression models to evaluate the association between total antibiotic volume (number of antibiotic prescriptions per patient visit), adjusted for multiple practice- and physician-level covariates, and unnecessary antibiotic prescribing.
There were 499 570 physician-patient encounters resulting in 152 853 antibiotic prescriptions from 341 physicians. Substantial inter-physician variability was observed. In the fully adjusted model, we observed a significant association between total antibiotic volume and unnecessary prescribing rate (adjusted rate ratio 2.11 per 10% increase in total use; 95% CI 2.05-2.17), and none of the practice- and physician-level variables were associated with unnecessary prescribing rate.
We demonstrated substantial inter-physician variability in unnecessary antibiotic prescribing in this cohort of family physicians. Total antibiotic use was strongly correlated with unnecessary antibiotic prescribing. Total antibiotic volume is a reasonable surrogate for unnecessary antibiotic use. These results can inform community antimicrobial stewardship efforts.
在加拿大，家庭医生开出的门诊抗生素处方中，约有 25%是不必要的。减少不必要的抗生素使用对于社区抗生素管理至关重要。然而，与总抗生素使用相比，不必要的抗生素使用更难衡量。我们调查了家庭医生总抗生素使用和不必要抗生素使用之间的关系，并评估了不必要抗生素处方开具的医生间差异。
这是一项基于加拿大安大略省家庭医生电子病历的队列研究，时间为 2011 年 4 月至 2016 年 3 月。我们使用 23 种常见初级保健情况的预先设定的预期抗生素处方率来计算不必要的抗生素处方率。我们使用多水平泊松回归模型来评估总抗生素量（每位患者就诊时开具的抗生素处方数量）与不必要的抗生素处方之间的关联，同时调整了多个实践和医生水平的混杂因素。
在 341 名医生的 499570 次医患就诊中，共开具了 152853 次抗生素处方。观察到医生间存在很大的差异。在完全调整的模型中，我们观察到总抗生素量与不必要处方率之间存在显著关联（调整后的比率比增加 10%总使用量的比率比为 2.11；95%CI 2.05-2.17），并且实践和医生水平的变量均与不必要处方率无关。
我们在这个家庭医生队列中发现了不必要的抗生素处方开具方面存在很大的医生间差异。总抗生素使用与不必要的抗生素使用密切相关。总抗生素量是不必要抗生素使用的合理替代指标。这些结果可以为社区抗菌药物管理工作提供信息。
