澳大利亚初任全科医生采用的即时和延迟抗生素处方策略：一项横断面分析。

Immediate and delayed antibiotic prescribing strategies used by Australian early-career GPs: a cross-sectional analysis.

机构信息

NSW & ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation, Australia.

Faculty of Medicine, University of Queensland, Brisbane, Australia.

出版信息

Br J Gen Pract. 2021 Nov 25;71(713):e895-e903. doi: 10.3399/BJGP.2021.0026. Print 2021 Dec.

DOI:10.3399/BJGP.2021.0026

PMID:34097641

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8574222/

Abstract

BACKGROUND

Antibiotics are overused for non-pneumonia acute respiratory tract infections (ARTIs).

AIM

To establish prevalence and explore associations of delayed and immediate antibiotic prescribing strategies of Australian early-career GPs (specialist GP vocational trainees, also known as GP registrars) for non-pneumonia ARTIs.

DESIGN AND SETTING

Cross-sectional analysis of data collected between September 2016 and December 2017 from the Registrar Clinical Encounters in Training cohort (ReCEnT) study, an ongoing cohort study of GP registrars' in-practice clinical experiences in four Australian states and territories.

METHOD

Multinomial logistic regression with outcome antibiotic prescribing (no prescribing, immediate prescribing, and delayed prescribing).

RESULTS

Of 7156 new ARTI diagnoses, no antibiotics were prescribed for 4892 (68%); antibiotics were prescribed for immediate use for 1614 diagnoses (23%) and delayed antibiotics were used for 650 diagnoses (9%). Delayed prescribing was used in 22% of otitis media, 16% of sinusitis, 13% of sore throat, 11% of acute bronchitis/bronchiolitis, and 5% of upper respiratory tract infection (URTI) diagnoses. Delayed prescribing was used for 29% of all prescriptions written. Delayed prescribing and immediate prescribing were associated with markers of clinical concern. Delayed prescribing was associated with longer duration of consultation and with fewer diagnoses/problems dealt with in the consultation.

CONCLUSION

Australian early-career GPs use no prescribing for ARTIs substantially more than established GPs; however, except where URTIs are concerned, they still prescribe antibiotics in excess of validated benchmarks. Australian early-career GPs may use delayed prescribing more often than European established GPs, and may use it to manage diagnostic uncertainty and, possibly, conflicting influences on prescribing behaviour. The use of delayed prescribing may enable a transition to an environment of more-rational antibiotic prescribing for ARTIs.

摘要

背景

抗生素在非肺炎急性呼吸道感染（ARTI）中的过度使用。

目的

确定澳大利亚初级保健医生（专科医生培训生，也称为 GP 注册医师）延迟和即刻开具抗生素治疗非肺炎 ARTI 的策略的流行情况，并探讨其相关因素。

设计和设置

这是一项横断面分析，数据来自于 2016 年 9 月至 2017 年 12 月期间，在正在进行的澳大利亚四个州和地区 GP 注册医师实践临床经验的注册临床遭遇研究（ReCEnT）中收集的。

方法

采用多分类逻辑回归分析，结果为抗生素的使用情况（不使用、即刻使用和延迟使用）。

结果

在 7156 例新的 ARTI 诊断中，4892 例（68%）未开具抗生素；1614 例（23%）即刻开具抗生素，650 例（9%）延迟开具抗生素。中耳炎的延迟处方使用率为 22%，鼻窦炎为 16%，咽痛为 13%，急性支气管炎/细支气管炎为 11%，上呼吸道感染（URTI）为 5%。延迟处方的使用率为所有开具处方的 29%。延迟处方和即刻处方与临床关注指标相关。延迟处方与更长的咨询时间和咨询中处理的诊断/问题较少相关。

结论

澳大利亚初级保健医生对 ARTI 不使用抗生素的情况比经验丰富的医生更为常见；然而，除 URTI 外，他们开具的抗生素仍然超过了验证过的基准。澳大利亚初级保健医生可能比欧洲经验丰富的医生更常使用延迟处方，可能是为了处理诊断不确定性，以及可能对处方行为产生影响的冲突因素。延迟处方的使用可能有助于向更合理的 ARTI 抗生素处方环境转变。