School of Public Policy (Leslie, Fadaak) Cumming School of Medicine, University of Calgary; Department of Community Health Sciences (Leslie) Cumming School of Medicine, University of Calgary; Clinical Research Unit (Lethebe, Hart Szostakiwskyj), Cumming School of Medicine, University of Calgary, Calgary, Alta.
CMAJ Open. 2023 Jul 4;11(4):E579-E586. doi: 10.9778/cmajo.20220114. Print 2023 Jul-Aug.
BACKGROUND: Antimicrobial resistance is a rising threat to human health, and, with up to 90% of antibiotics prescribed in the community, it is critical to examine Canadian antibiotic stewardship practices in outpatient settings. We carried out a large-scale analysis of appropriateness in community-based prescribing of antibiotics to adults in Alberta, reporting on 3 years of data from physicians practising in the province. METHODS: The study cohort was composed of all adult (age 18-65 yr) Alberta residents who filled at least 1 antibiotic prescription written by a community-based physician between Apr. 1, 2017, and Mar. 6, 2020. We linked diagnosis codes from the clinical modification of the (ICD-9-CM), as used for billing purposes by the province's fee-for-service community physicians, to drug dispensing records, as maintained in the province's pharmaceutical dispensing database. We included physicians practising in community medicine, general practice, generalist mental health, geriatric medicine and occupational medicine. Following an approach used in previous research, we linked diagnosis codes with antibiotic drug dispensations, classified across a spectrum of appropriateness (always, sometimes never, no diagnosis code). RESULTS: We identified 3 114 400 antibiotic prescriptions dispensed to 1 351 193 adult patients by 5577 physicians. Of these prescriptions, 253 038 (8.1%) were "always appropriate," 1 168 131 (37.5%) were "potentially appropriate," 1 219 709 (39.2%) were "never appropriate," and 473 522 (15.2%) were not associated with an ICD-9-CM billing code. Among all dispensed antibiotic prescriptions, amoxicillin, azithromycin and clarithromycin were the most commonly prescribed drugs labelled "never appropriate." INTERPRETATION: We found that nearly 40% of prescriptions dispensed to 1.35 million adult patients in Alberta's community-based settings over a 35-month period were inappropriate. This finding suggests that additional policies and programs to improve stewardship among physicians prescribing antibiotics for adult outpatients in Alberta may be warranted.
背景：抗菌药物耐药性对人类健康构成日益严重的威胁，而在社区中开具的抗生素多达 90%，因此，迫切需要检查加拿大在门诊环境下的抗生素管理实践。我们对艾伯塔省社区医生开具的成人抗生素处方的适宜性进行了大规模分析，报告了该省 3 年的数据。
方法：研究队列由 2017 年 4 月 1 日至 2020 年 3 月 6 日期间至少使用 1 种社区医生开具的抗生素处方的所有艾伯塔省成年（18-65 岁）居民组成。我们将临床修改版的（ICD-9-CM）诊断代码与药物配药记录相关联，该记录由该省按服务计费的社区医生用于计费目的，并由该省的药物配药数据库维护。我们包括从事社区医学、全科医学、全科心理健康、老年医学和职业医学的医生。按照之前研究中使用的方法，我们将诊断代码与抗生素药物配药相关联，将其分类为适宜性范围（始终、有时、从不、无诊断代码）。
结果：我们确定了 5577 名医生向 1351193 名成年患者开出的 3114400 种抗生素处方。这些处方中，253038 种（8.1%）为“始终适宜”，1168131 种（37.5%）为“可能适宜”，1219709 种（39.2%）为“从不适宜”，473522 种（15.2%）与 ICD-9-CM 计费代码无关。在所有开出的抗生素处方中，阿莫西林、阿奇霉素和克拉霉素是标签为“从不适宜”的最常用药物。
解释：我们发现，在艾伯塔省社区环境下，35 个月内开出的 135 万成年患者的处方中，近 40%是不适当的。这一发现表明，可能需要在艾伯塔省为成年门诊患者开具抗生素的医生中制定额外的政策和计划，以改善管理。
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