Machowska Anna, Marrone Gaetano, Saliba-Gustafsson Peter, Borg Michael A, Saliba-Gustafsson Erika A, Stålsby Lundborg Cecilia
Department of Global Public Health, Health Systems and Policy: Improving Use of Medicines, Karolinska Institutet, 171 77 Stockholm, Sweden.
Center for Molecular Medicine at BioClinicum, Cardiovascular Medicine Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital Solna, 171 76 Stockholm, Sweden.
Antibiotics (Basel). 2021 Mar 31;10(4):371. doi: 10.3390/antibiotics10040371.
Antibiotics are commonly prescribed in primary care for acute respiratory tract complaints (aRTCs), often inappropriately. Social marketing interventions could improve prescribing in such settings. We evaluate the impact of a social marketing intervention on general practitioners' (GPs') antibiotic prescribing for aRTCs in Malta. Changes in GPs' antibiotic prescribing were monitored over two surveillance periods between 2015 and 2018. Primary outcome: change in antibiotic prescription for aRTCs. Secondary outcomes: change in antibiotic prescription: (i) for immediate use, (ii) for delayed antibiotic prescription, (iii) by diagnosis, and (iv) by antibiotic class. Data were analysed using clustered analysis and interrupted time series analysis (ITSA). Of 33 participating GPs, 18 successfully completed the study. Although clustered analyses showed a significant 3% decrease in overall antibiotic prescription ( 0.024), ITSA showed no significant change overall ( 0.264). Antibiotic prescription decreased significantly for the common cold ( < 0.001), otitis media ( 0.044), and sinusitis ( 0.004), but increased for pharyngitis ( 0.015). The intervention resulted in modest improvements in GPs' antibiotic prescribing. A more top-down approach will likely be required for future initiatives to be successful in this setting, focusing on diagnostic and prescribing support like rapid diagnostic testing, prescribing guidelines, and standardised delayed antibiotic prescriptions.
在初级保健中，抗生素常用于治疗急性呼吸道疾病（aRTCs），且使用往往不当。社会营销干预措施可能会改善此类情况下的处方行为。我们评估了一项社会营销干预措施对马耳他全科医生（GPs）治疗aRTCs时抗生素处方的影响。在2015年至2018年的两个监测期内，对全科医生抗生素处方的变化进行了监测。主要结果：aRTCs抗生素处方的变化。次要结果：抗生素处方的变化：（i）即时使用的处方变化，（ii）延迟抗生素处方的变化，（iii）按诊断分类的处方变化，以及（iv）按抗生素类别分类的处方变化。使用聚类分析和中断时间序列分析（ITSA）对数据进行了分析。在33名参与的全科医生中，18名成功完成了研究。尽管聚类分析显示总体抗生素处方显著下降了3%（P = 0.024），但ITSA显示总体上没有显著变化（P = 0.264）。普通感冒（P < 0.001）、中耳炎（P = 0.044）和鼻窦炎（P = 0.004）的抗生素处方显著减少，但咽炎的抗生素处方增加（P = 0.015）。该干预措施使全科医生的抗生素处方有适度改善。未来在此类情况下若要成功开展举措，可能需要采取更自上而下的方法，重点关注诊断和处方支持，如快速诊断检测、处方指南以及标准化的延迟抗生素处方。
