King Laura M, Tsay Sharon V, Hicks Lauri A, Bizune Destani, Hersh Adam L, Fleming-Dutra Katherine
Division of Healthcare Quality and Promotion, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
Department of Pediatrics, Division of Infectious Diseases, University of Utah, Salt Lake City, Utah.
Antimicrob Steward Healthc Epidemiol. 2021 Dec 17;1(1):1-8. doi: 10.1017/ash.2021.230.
To describe acute respiratory illnesses (ARI) visits and antibiotic prescriptions in 2011 and 2018 across outpatient settings to evaluate progress in reducing unnecessary antibiotic prescribing for ARIs.
Cross-sectional study.
Outpatient medical and pharmacy claims captured in the IBM MarketScan commercial database, a national convenience sample of privately insured individuals aged <65 years.
We calculated the annual number of ARI visits and visits with oral antibiotic prescriptions per 1,000 enrollees overall and by age category, sex, and setting in 2011 and 2018. We compared these and calculated prevalence rate ratios (PRRs). We adapted existing tiered-diagnosis methodology for (ICD-10-CM) codes.
In our study population, there were 829 ARI visits per 1,000 enrollees in 2011 compared with 760 ARI visits per 1,000 enrollees in 2018. In 2011, 39.3% of ARI visits were associated with ≥1 oral antibiotic prescription versus 36.2% in 2018. In 2018 compared with 2011, overall ARI visits decreased 8% (PRR, 0.92; 99.99% confidence interval [CI], 0.92-0.92), whereas visits with antibiotic prescriptions decreased 16% (PRR, 0.84; 99.99% CI, 0.84-0.85). Visits for antibiotic-inappropriate ARIs decreased by 9% (PRR, 0.91; 99.99% CI, 0.91-0.92), and visits with antibiotic prescriptions for these conditions decreased by 32% (PRR, 0.68; 99.99% CI, 0.67-0.68) from 2011 to 2018.
Both the rate of antibiotic prescriptions per 1,000 enrollees and the percentage of visits with antibiotic prescriptions decreased modestly from 2011 to 2018 in our study population. These decreases were greatest for antibiotic-inappropriate ARIs; however, additional reductions in inappropriate antibiotic prescribing are needed.
描述2011年和2018年门诊环境下的急性呼吸道疾病（ARI）就诊情况及抗生素处方，以评估在减少ARI不必要抗生素处方方面取得的进展。
横断面研究。
IBM MarketScan商业数据库中记录的门诊医疗和药房索赔数据，这是一个年龄＜65岁的私人保险个体的全国便利样本。
我们计算了2011年和2018年每1000名参保者中ARI就诊的年度数量以及开具口服抗生素处方的就诊数量，并按年龄类别、性别和就诊地点进行分类。我们对这些数据进行比较并计算患病率比（PRR）。我们对现有的分层诊断方法进行了调整以用于（国际疾病分类第十次修订本临床修正版，ICD - 10 - CM）编码。
在我们的研究人群中，2011年每1000名参保者中有829次ARI就诊，而2018年每1000名参保者中有760次ARI就诊。2011年，39.3%的ARI就诊与≥1张口服抗生素处方相关，而2018年这一比例为36.2%。与2011年相比，2018年总体ARI就诊次数减少了8%（PRR，0.92；99.99%置信区间[CI]，0.92 - 0.92），而开具抗生素处方的就诊次数减少了16%（PRR，0.84；99.99% CI，0.84 - 0.85）。不适合使用抗生素的ARI就诊次数减少了9%（PRR，0.91；99.99% CI，0.91 - 0.92），从2011年到2018年，针对这些情况开具抗生素处方的就诊次数减少了32%（PRR，0.68；99.99% CI，0.67 - 0.68）。
在我们的研究人群中，从2011年到2018年，每1000名参保者的抗生素处方率以及开具抗生素处方的就诊百分比均有适度下降。这些下降在不适合使用抗生素的ARI中最为明显；然而，仍需要进一步减少不适当的抗生素处方。
