Leung Valerie, Langford Bradley J, Ha Rita, Schwartz Kevin L
Public Health Ontario, ON, Canada.
Toronto East Health Network, Michael Garron Hospital, ON, Canada.
JAC Antimicrob Resist. 2021 Jul 19;3(3):dlab098. doi: 10.1093/jacamr/dlab098. eCollection 2021 Sep.
Antimicrobial stewardship interventions in outpatient settings are diverse and a variety of outcomes have been used to evaluate these efforts. This narrative review describes, compares and provides specific examples of antibiotic use and other prescribing measures to help antimicrobial stewards better understand, interpret and implement metrics for this setting. A variety of data have been used including those generated from drug sales, prescribing and dispensing activities, however data generated closest to when an individual patient consumes an antibiotic is usually more accurate for estimating antibiotic use. Availability of data is often dependent on context such as information technology infrastructure and the healthcare system under consideration. While there is no ideal antibiotic use or prescribing metric for evaluating antimicrobial stewardship activities in the outpatient setting, the intervention of interest and available data sources are important factors. Common metrics for estimating antimicrobial use include DDD per 1000 inhabitants per day (DID) and days of therapy per 1000 inhabitants/day (DOTID). Other prescribing metrics such as antibiotic prescribing rate (APR), proportion of prescriptions containing an antibiotic, proportion of prolonged antibiotic courses prescribed, estimated appropriate APR and quality indicators are used to assess specific aspects of antimicrobial prescribing behaviour such as initiation, selection, duration and appropriateness. Understanding the context of prescribing practices helps to ensure feasibility and relevance when implementing metrics and targets for improvement in the outpatient setting.
门诊环境中的抗菌药物管理干预措施多种多样，人们使用了各种结果指标来评估这些措施。本叙述性综述描述、比较并提供了抗生素使用及其他处方措施的具体示例，以帮助抗菌药物管理者更好地理解、解释和实施适用于该环境的指标。人们使用了各种数据，包括来自药品销售、处方开具和配药活动的数据，然而，最接近个体患者使用抗生素时间所产生的数据通常在估计抗生素使用情况时更为准确。数据的可用性往往取决于具体情况，如信息技术基础设施和所考虑的医疗保健系统。虽然在门诊环境中没有评估抗菌药物管理活动的理想抗生素使用或处方指标，但感兴趣的干预措施和可用数据源是重要因素。估计抗菌药物使用情况的常见指标包括每千居民每天的限定日剂量（DID）和每千居民每天的治疗天数（DOTID）。其他处方指标，如抗生素处方率（APR）、含抗生素处方的比例、延长抗生素疗程的处方比例、估计的适当APR和质量指标，用于评估抗菌药物处方行为的特定方面，如起始、选择、疗程和适当性。了解处方实践的背景有助于确保在门诊环境中实施改进指标和目标时的可行性和相关性。
