Ann Fam Med. 2022 Apr 1;20(20 Suppl 1):2678. doi: 10.1370/afm.20.s1.2678.
Acute bronchitis is a common reason patients seek primary care and has predominately viral causes. Yet, antibiotics are often prescribed despite limited evidence of clinical benefit. Interventions targeting antibiotic prescribing for acute bronchitis have reduced prescribing, but rates continued to remain higher than expected. There is also a paucity of data describing variability in antibiotic prescribing and its determinants; specifically, non-clinical, patient-level factors. Identifying non-clinical determinants of antibiotic prescribing for bronchitis could inform better care for these patients in primary care.
To assess the impact of geo-demographic factors on antibiotic prescribing for ambulatory adults with acute, uncomplicated bronchitis.
Cohort study.
Ambulatory clinics, urgent cares and emergency departments within a large, single U.S. health-system.
Adult patients with a primary diagnosis of bronchitis in 2019.
Predictors of antibiotic prescribing.
There were 63,051 unique patients (mean age 48±18 years); 62.7% were female and 78.7% were non-Hispanic Caucasians. Of providers, 66.7% were physicians. Patients who were older (aOR 1.02, 95% CI 1.02-1.02), male (1.06, 1.03-1.10), black (1.21, 1.14-1.29), smoked (1.16, 1.12-1.20), had a nurse practitioner v. physician provider (1.11, 1.06-1.16) or a physician assistant v. physician provider (1.06, 1.01-1.11) were more likely to receive antibiotics. Patients who were Hispanic (0.87, 0.82-0.94), or Asian (0.85, 0.75-0.96) were less likely to receive antibiotics. Additionally, patients who had Medicare (0.78, 0.74-0.82), Medicaid (0.73, 0.69-0.77) or Exchange insurance (0.90, 0.82-0.98) or lived in a U.S. Census Block group with larger number of households without vehicles (0.66, 0.52-0.85) were less likely to receive antibiotics. Those living in an area with more owner-occupied housing were more likely to receive antibiotics (1.39, 1.25-1.53). The distance between a patient's residence and the encounter location did not impact the likelihood of antibiotic prescribing.
This study identified antibiotic prescribing disparities for adults with acute bronchitis at the level of the patient, prescriber and the patient residential area. Interventions targeting antibiotic prescribing in this population should consider the role these factors have in prescribing decisions.
急性支气管炎是患者寻求初级保健的常见原因，主要由病毒引起。然而，尽管临床获益的证据有限，抗生素仍经常被开处。针对急性支气管炎开处抗生素的干预措施减少了抗生素的开处，但比率仍然高于预期。描述抗生素开处的变异性及其决定因素的资料也很少；具体来说，是临床以外的、患者层面的因素。确定急性支气管炎抗生素开处的非临床决定因素可以为这些患者在初级保健中的更好护理提供信息。
评估地理人口因素对门诊成年急性、单纯性支气管炎患者抗生素开处的影响。
队列研究。
美国一个大型单一医疗系统的门诊诊所、紧急护理和急诊部门。
2019 年患有原发性支气管炎的成年患者。
抗生素开处的预测因素。
共有 63051 名患者（平均年龄 48±18 岁）；62.7%为女性，78.7%为非西班牙裔白种人。在提供者中，66.7%为医生。年龄较大的患者（OR1.02，95%CI1.02-1.02）、男性（1.06，1.03-1.10）、黑人（1.21，1.14-1.29）、吸烟（1.16，1.12-1.20）、有执业护士而不是医生提供者（1.11，1.06-1.16）或医师助理而不是医生提供者（1.06，1.01-1.11）更有可能接受抗生素治疗。西班牙裔（0.87，0.82-0.94）或亚裔（0.85，0.75-0.96）的患者接受抗生素治疗的可能性较低。此外，医疗保险（0.78，0.74-0.82）、医疗补助（0.73，0.69-0.77）或交换保险（0.90，0.82-0.98）的患者或居住在美国普查街区组中车辆较少的家庭（0.66，0.52-0.85）的患者不太可能接受抗生素治疗。居住在拥有更多业主自住房屋的地区的患者更有可能接受抗生素治疗（1.39，1.25-1.53）。患者居住地与就诊地点之间的距离不会影响抗生素开处的可能性。
本研究在患者、开处方者和患者居住地区层面确定了急性支气管炎成年患者的抗生素开处差异。针对该人群的抗生素开处干预措施应考虑这些因素在开处方决策中的作用。
