Fischer Michael A, Mahesri Mufaddal, Lii Joyce, Linder Jeffrey A
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, Massachusetts, USA.
Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Open Forum Infect Dis. 2021 Aug 1;8(9):ofab412. doi: 10.1093/ofid/ofab412. eCollection 2021 Sep.
Ambulatory antibiotic prescriptions without a clinic visit or without documentation of infection could represent overuse and contribute to adverse outcomes. We aim to describe US ambulatory antibiotic prescribing, including those without an associated visit or infection diagnosis.
We conducted an observational cohort study using data of all patients receiving antibacterial, antibiotic prescriptions from 04/01/2016 to 06/30/2018 in a large US private health insurance plan. We identified outpatient antibiotic prescriptions as (1) associated with a clinician visit and an infection-related diagnosis; (2) associated with a clinician visit but no infection-related diagnosis; or (3) not associated with an in-person clinician visit in the 7 days before the prescription (non-visit-based). We then assessed whether non-visit-based antibiotic prescriptions (NVBAPs) differed from visit-based antibiotics by patient, clinician, or antibiotic characteristics using multivariable models.
The cohort included 8.6M enrollees who filled 22.3M antibiotic prescriptions. NVBAP accounted for 31% (6.9M) of fills, and non-infection-related prescribing accounted for 22% (4.9M). NVBAP rates were lower for children than for adults (0-17 years old, 16%; 18-64 years old, 33%; >65 years old, 34%). Among most commonly prescribed antibiotic classes, NVBAP was highest for penicillins (36%) and lowest for cephalosporins (25%) and macrolides (25%). Specialist physicians had the highest rate of NVBAP (38%), followed by internists (28%), family medicine (20%), and pediatricians (10%). In multivariable models, NVBAP was associated with increasing age, and NVBAP was less likely for patients in the South, those with more baseline clinical visits, or those with chronic lung disease.
Over half of ambulatory antibiotic use was either non-visit-based or non-infection-related. Particularly given health care changes due to the coronavirus disease 2019 pandemic, efforts to improve antibiotic prescribing must account for non-visit-based and non-infection-related prescribing.
无需门诊就诊或无感染记录的门诊抗生素处方可能存在过度使用的情况，并会导致不良后果。我们旨在描述美国门诊抗生素处方情况，包括那些无相关就诊或感染诊断的处方。
我们进行了一项观察性队列研究，使用了2016年4月1日至2018年6月30日期间美国一项大型私人医疗保险计划中所有接受抗菌、抗生素处方患者的数据。我们将门诊抗生素处方确定为：(1) 与临床医生就诊及感染相关诊断相关；(2) 与临床医生就诊相关但无感染相关诊断；或(3) 在处方前7天内与面对面临床医生就诊无关（非基于就诊）。然后，我们使用多变量模型评估非基于就诊的抗生素处方（NVBAP）在患者、临床医生或抗生素特征方面是否与基于就诊的抗生素不同。
该队列包括860万参保人，他们共开具了2230万份抗生素处方。NVBAP占处方量的31%（690万份），与感染无关的处方占比为22%（490万份）。儿童的NVBAP率低于成人（0至17岁，16%；18至64岁，33%；>65岁，34%）。在最常开具的抗生素类别中，青霉素类的NVBAP最高（36%），头孢菌素类（25%）和大环内酯类（25%）最低。专科医生的NVBAP率最高（38%），其次是内科医生（28%）、家庭医学医生（20%）和儿科医生（10%）。在多变量模型中，NVBAP与年龄增长相关，而南部地区的患者、基线临床就诊次数较多的患者或患有慢性肺病的患者开具NVBAP的可能性较小。
超过一半的门诊抗生素使用要么是非基于就诊的，要么是与感染无关的。特别是考虑到2019年冠状病毒病大流行导致的医疗保健变化，改善抗生素处方的努力必须考虑到非基于就诊和与感染无关的处方情况。
