From Department of Pharmacy Services, Advocate Aurora Health, Milwaukee, WI (TJD); Advocate Aurora Research Institute, Advocate Aurora Health, Milwaukee, WI (KH); Aurora UW Medical Group, Aurora Sinai Medical Center, Advocate Aurora Health, Milwaukee, WI (KH, JK); Center for Urban Population Health, Milwaukee, WI (JK, DB); Department of Family Medicine, Aurora UW Medical Group, Aurora St. Luke's Medical Center, Advocate Aurora Health, Milwaukee, WI (DB).
J Am Board Fam Med. 2022 Jul-Aug;35(4):733-741. doi: 10.3122/jabfm.2022.04.210452.
To assess the impact of geodemographic factors on antibiotic prescribing for adult acute, uncomplicated bronchitis or upper respiratory tract infection.
A retrospective, observational study of 63,051 single health-system, outpatient discharges with a primary diagnosis of bronchitis or upper respiratory tract infection in 2019. Univariate analyses of prescribing predictors and multivariable stepwise logistic modeling were performed.
Patients who were older (aOR 1.02; 95% CI 1.02, 1.02), male (1.10; 1.06, 1.14), black (1.29; 1.22, 1.38), smoked (1.18; 1.14, 1.23), seen in urgent care (1.26; 1.22, 1.31) and living in an area with more owner-occupied housing (1.41; 1.30, 1.53) were more likely to receive antibiotics. Patients who were Asian (0.88; 0.77, 0.99), had Medicare (0.83; 0.78, 0.87), Medicaid (0.84; 0.79, 0.87) or Exchange insurance (0.90; 0.82, 0.98), or seen in the emergency department (0.43; 0.40, 0.46) were less likely to receive antibiotics. Distance from a patient's address and their encounter location did not predict antibiotic prescribing.
Antibiotic prescribing interventions for adult acute bronchitis and upper respiratory tract infections could target patients living in an area with higher socioeconomic status.
评估地理人口因素对成人急性单纯性支气管炎或上呼吸道感染抗生素处方的影响。
对 2019 年单一医疗系统门诊 63051 例支气管炎或上呼吸道感染初诊患者进行回顾性观察性研究。对处方预测因素进行单变量分析，并进行多变量逐步逻辑回归建模。
年龄较大（aOR 1.02；95%CI 1.02，1.02）、男性（1.10；1.06，1.14）、黑人（1.29；1.22，1.38）、吸烟（1.18；1.14，1.23）、在紧急护理中就诊（1.26；1.22，1.31）和居住在业主自住房屋较多的地区（1.41；1.30，1.53）的患者更有可能接受抗生素治疗。亚洲患者（0.88；0.77，0.99）、医疗保险（0.83；0.78，0.87）、医疗补助（0.84；0.79，0.87）或交易所保险（0.90；0.82，0.98）、或在急诊就诊（0.43；0.40，0.46）的患者接受抗生素治疗的可能性较低。患者地址与就诊地点之间的距离不能预测抗生素的使用。
针对成人急性支气管炎和上呼吸道感染的抗生素处方干预措施可以针对居住在社会经济地位较高地区的患者。
