Jensen P M, Lous J
Institute for General Practice, University of Aarhus, Denmark.
Scand J Prim Health Care. 1998 Mar;16(1):18-23. doi: 10.1080/028134398750003359.
To assess implicit criteria (i.e. what the general practitioner (GP) considers good clinical practice) for and performance (i.e. what the GP actually does) with regard to antibiotic treatment of acute otitis media in Danish general practice.
a) Criteria assessed by survey among general practitioners. b) Performance assessed by prospective registration of consultations with general practitioners related to otitis media.
General practices in three Danish counties.
a) All the GPs in the three countries (n = 790). b) 368 children with acute otitis media.
a) Criteria for timing of treatment and first drug of choice for acute otitis media; b) prescribed antibiotics and multivariate analysis of factors predicting antibiotic prescription.
a) The response rate was 72%. Only 51% (95% CI 47-55) of GPs would give antibiotics to all children with acute otitis media, and 79% (95% CI 76-82) of GPs would use penicillin-V as first drug of choice. b) Seventy-four per cent (95% CI 68-81) of children with acute otitis media were given antibiotics. Factors predicting the GPs' decision to prescribe antibiotics were the general condition of the child and the factors that are normally used in diagnosing the condition.
Danish general practitioners' criteria for antibiotic treatment of acute otitis media are restrictive, with non-antibiotic treatment in cases of short duration and penicillin-V as first drug of choice. Performance suggests a less restrictive pattern.
评估丹麦全科医疗中急性中耳炎抗生素治疗的隐性标准（即全科医生认为的良好临床实践）及实际执行情况（即全科医生实际采取的做法）。
a）通过对全科医生进行调查评估标准。b）通过前瞻性登记与中耳炎相关的全科医生会诊来评估执行情况。
丹麦三个郡的全科医疗诊所。
a）三个郡的所有全科医生（n = 790）。b）368名患有急性中耳炎的儿童。
a）急性中耳炎治疗时机及首选药物的标准；b）开具的抗生素以及预测抗生素处方的因素的多变量分析。
a）应答率为72%。只有51%（95%可信区间47 - 55）的全科医生会给所有患有急性中耳炎的儿童使用抗生素，79%（95%可信区间76 - 82）的全科医生会将青霉素V作为首选药物。b）74%（95%可信区间68 - 81）患有急性中耳炎的儿童接受了抗生素治疗。预测全科医生开具抗生素决定的因素是儿童的一般状况以及通常用于诊断病情的因素。
丹麦全科医生对急性中耳炎抗生素治疗的标准较为严格，病程短的病例采用非抗生素治疗，首选药物为青霉素V。实际执行情况显示出限制较少的模式。
