Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA.
Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
J Am Med Dir Assoc. 2024 May;25(5):769-773.e9. doi: 10.1016/j.jamda.2024.01.019. Epub 2024 Feb 27.
To identify whether differences in antibiotic prescribing practices by prescriber type and specialization in nursing home (NH) care exist for urinary tract infection (UTI) and pneumonia.
Retrospective cohort.
This national study included antibiotic dispensings to traditional Medicare beneficiaries aged ≥65 years with UTI or pneumonia infections residing long-term (≥100 days) in US NHs between 2016 and 2018.
Minimum Data Set assessment data were linked to Medicare data [Part D prescription drug, inpatient hospital (MedPAR), prescriber characteristics, and enrollment]. We compared antibiotic prescribing patterns by prescriber type [physician vs advanced practice practitioner (AP)] and NH specialization (≥90% vs <90% of all associated medication dispensings to NH residents). Antibiotic dispensing measures included the total number of dispensings and duration of therapy (median number of days supplied) by antibiotic class.
There were 264,735 antibiotic dispensings prescribed by 32,437 prescribers for 140,360 residents in 14,035 NHs. NH specialists were less likely to prescribe fluoroquinolones for UTI (22.9% NH specialist physician, 23.9% non-NH specialist physician, 21.3% NH specialist AP, 24.2% non-NH specialist AP), but more likely to prescribe fluoroquinolones for pneumonia (38.9%, 37.8%, 38.8%, 37.3%, respectively). Over time, NH specialists reduced fluoroquinolone prescribing for pneumonia to a greater extent than non-NH specialists. The duration of therapy was similar across prescriber groups for UTI, but longer among non-NH specialist APs for several antibiotic classes for pneumonia, including tetracyclines, glycopeptides and lipoglycopeptides, and metronidazole.
There were differences in antibiotic prescribing patterns by prescriber type and specialization in NH care between 2016 and 2018. Understanding how antibiotic prescribing differs based on prescriber characteristics is essential to inform antibiotic stewardship efforts. Tailoring antibiotic stewardship efforts to prescribers by NH specialization is rational given differences in antibiotic prescribing patterns based on NH specialization.
确定在养老院（NH）护理中，医生和护士从业者类型以及专业领域的不同是否会导致抗生素的使用存在差异，这种差异在治疗尿路感染（UTI）和肺炎时是否存在。
回顾性队列研究。
本研究纳入了 2016 年至 2018 年期间，在美国 NH 中居住时间超过 100 天的年龄在 65 岁以上患有 UTI 或肺炎感染的传统医疗保险受益人，通过最小数据集评估数据与医疗保险数据（处方药物部分 D、住院医院（MedPAR）、医生特征和登记）进行了关联。我们根据医生类型（医生与高级执业护士（AP））和 NH 专业程度（≥90%与<90%与 NH 居民相关的所有药物分配）比较了抗生素的使用模式。抗生素使用的衡量标准包括每个抗生素类别的总用药量和疗程（供应天数中位数）。
在 14035 家 NH 中，有 32437 名医生为 264735 名居民开具了处方，共涉及 140360 名居民。NH 专家开具氟喹诺酮类药物治疗 UTI 的可能性较小（22.9% NH 专家医生、23.9%非 NH 专家医生、21.3% NH 专家 AP、24.2%非 NH 专家 AP），但更有可能开具氟喹诺酮类药物治疗肺炎（分别为 38.9%、37.8%、38.8%、37.3%）。随着时间的推移，NH 专家减少了肺炎患者氟喹诺酮类药物的使用，而非 NH 专家则减少得较少。在 UTI 方面，不同医生组之间的疗程相似，但非 NH 专家 AP 开具几种抗生素的疗程更长，包括四环素类、糖肽类和糖肽脂类、甲硝唑。
在 2016 年至 2018 年期间，医生类型和 NH 护理专业程度的不同导致了抗生素使用模式的不同。了解基于医生特征的抗生素使用情况的差异对于指导抗生素管理工作至关重要。鉴于 NH 专业程度的不同会导致抗生素使用模式的差异，因此根据 NH 专业程度来制定抗生素管理工作的侧重点是合理的。
