基层医疗中抗生素处方的审核与反馈干预措施：一项系统评价与荟萃分析
Audit and Feedback Interventions for Antibiotic Prescribing in Primary Care: A Systematic Review and Meta-analysis.
作者信息
Xu Alice X T, Brown Kevin, Schwartz Kevin L, Aghlmandi Soheila, Alderson Sarah, Brehaut Jamie C, Brown Benjamin C, Bucher Heiner C, Clarkson Janet, De Sutter An, Francis Nick A, Grimshaw Jeremy, Gunnarsson Ronny, Hallsworth Michael, Hemkens Lars, Høye Sigurd, Khan Tasneem, Lecky Donna M, Leung Felicia, Leung Jeremy, Lindbæk Morten, Linder Jeffrey A, Llor Carl, Little Paul, O'Connor Denise, Pulcini Céline, Ramlackhan Kalisha, Ramsay Craig R, Sundvall Pär-Daniel, Taljaard Monica, Touboul Lundgren Pia, Vellinga Akke, Verbakel Jan Y, Verheij Theo J, Wikberg Carl, Ivers Noah
机构信息
Public Health Ontario, Toronto, Ontario, Canada.
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
出版信息
Clin Infect Dis. 2025 Feb 24;80(2):253-262. doi: 10.1093/cid/ciae604.
BACKGROUND
This systematic review evaluates the effect of audit and feedback (A&F) interventions targeting antibiotic prescribing in primary care and examines factors that may explain the variation in effectiveness.
METHODS
Randomized controlled trials (RCTs) involving A&F interventions targeting antibiotic prescribing in primary care were included in the systematic review. Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and ClinicalTrials.gov were searched up to May 2024. Trial, participant, and intervention characteristics were extracted independently by 2 researchers. Random effects meta-analyses of trials that compared interventions with and without A&F were conducted for 4 outcomes: (1) total antibiotic prescribing volume; (2) unnecessary antibiotic initiation; (3) excessive prescription duration, and (4) broad-spectrum antibiotic selection. A stratified analysis was also performed based on study characteristics and A&F intervention design features for total antibiotic volume.
RESULTS
A total of 56 RCTs fit the eligibility criteria and were included in the meta-analysis. A&F was associated with an 11% relative reduction in antibiotic prescribing volume (N = 21 studies, rate ratio [RR] = 0.89; 95% confidence interval [CI]: .84, .95; I2 = 97); 23% relative reduction in unnecessary antibiotic initiation (N = 16 studies, RR = 0.77; 95% CI: .68, .87; I2 = 72); 13% relative reduction in prolonged duration of antibiotic course (N = 4 studies, RR = 0.87 95% CI: .81, .94; I2 = 86); and 17% relative reduction in broad-spectrum antibiotic selection (N = 17 studies, RR = 0.83 95% CI: .75, .93; I2 = 96).
CONCLUSIONS
A&F interventions reduce antibiotic prescribing in primary care. However, heterogeneity was substantial, outcome definitions were not standardized across the trials, and intervention fidelity was not consistently assessed. Clinical Trials Registration. Prospero (CRD42022298297).
背景
本系统评价评估了针对初级保健中抗生素处方的审核与反馈（A&F）干预措施的效果，并研究了可能解释效果差异的因素。
方法
本系统评价纳入了涉及针对初级保健中抗生素处方的A&F干预措施的随机对照试验（RCT）。截至2024年5月，检索了Cochrane对照试验中心注册库、MEDLINE、EMBASE、CINAHL和ClinicalTrials.gov。由2名研究人员独立提取试验、参与者和干预措施的特征。对比较有和没有A&F干预措施的试验进行随机效应荟萃分析，涉及4个结局：（1）抗生素处方总量；（2）不必要的抗生素起始使用；（3）过长的处方疗程；（4）广谱抗生素的选择。还根据研究特征和A&F干预措施设计特点对总抗生素量进行了分层分析。
结果
共有56项RCT符合纳入标准并被纳入荟萃分析。A&F与抗生素处方量相对减少11%相关（N = 2项研究，率比[RR] = 0.89；95%置信区间[CI]：0.84，0.95；I² = 97）；不必要的抗生素起始使用相对减少23%（N = 16项研究，RR = 0.77；95% CI：0.68，0.87；I² = 72）；抗生素疗程延长相对减少13%（N = 4项研究，RR = 0.87，95% CI：0.81，0.94；I² = 86）；广谱抗生素选择相对减少17%（N = 17项研究，RR = 0.83，95% CI：0.75，0.93；I² = 96）。
结论
A&F干预措施可减少初级保健中的抗生素处方。然而，异质性很大，各试验的结局定义未标准化，且未始终如一地评估干预措施的保真度。临床试验注册。Prospero（CRD42022298297）。
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