CMAJ:医生的历史处方行为对抗菌药物开始、选择和治疗时间的影响

2017-08-11 何娜 环球医学资讯

在长期保健机构中,抗菌药物是最常见的处方药之一。但许多处方都存在不合适或药物使用疗程过长等问题。这意味着这些机构附近的居民有可能暴露于可避免的伤害,包括过敏、器官特异毒和产生耐药性等。2017年6月,发表在《CMAJ》的一项由加拿大科学家进行的研究,考察了长期照机构中,医生的历史处方行为是否能预测当前的处方行为。

在长期保健机构中,抗菌药物是最常见的处方药之一。但许多处方都存在不合适或药物使用疗程过长等问题。这意味着这些机构附近的居民有可能暴露于可避免的伤害,包括过敏、器官特异毒和产生耐药性等。2017年6月,发表在《CMAJ》的一项由加拿大科学家进行的研究,考察了长期照机构中,医生的历史处方行为是否能预测当前的处方行为。

背景:理解临床医生当前的抗菌药物处方行为在多大程度受历史实践模式影响将有助于采取针对性干预措施来优化长期保健中的抗菌药物使用。本研究的目的为评估医生的历史处方行为是否会影响长期保健机构患者抗菌药物治疗的开始、疗程延长和类别选择。

方法:研究人员进行了一项回顾性队列研究,研究对象为2014年1月1日~12月31日,安大略省长期保健机构中为患者开具抗菌药物处方的所有医生。从3个角度检测了医生抗菌药物处方的差异:抗菌药物治疗的开始、超过7天的延长使用、氟喹诺酮类药物的选择。带有控制范围的漏斗图用于确定差异的程度,并将医生在每个方面的倾向描述为极低、低、平均、高和极高几个程度。多变量逻辑回归用于评估医生之前几年的处方倾向是否可以预测当前的处方模式,并调整了患者的人口统计学、合并症、功能状态和留置管路。

结果:1695名长期保健医生为93132名患者开具了处方,在开始抗菌药物治疗(中位45%的患者,四分位范围(IQR),32%~55%)、延长治疗时间(中位30%的抗菌药物处方,IQR,19%~46%)和氟喹诺酮类药物的选择(中位27%的抗菌药物处方,IQR,18%~37%)上具有广泛的差异。2014年医生的抗菌药物处方倾向与之前几年的处方倾向强烈相关。控制了住院医师个体特征后,既往处方倾向为当前实践的显着预测因素。

结论:医生抗菌药物处方中,抗菌药物治疗开始、延长治疗时间和类别选择表现出个体化、可衡量和历史性倾向的趋势。处方审核和反馈有希望成为优化长期保健机构中的抗菌药物使用的方法。

原始出处:
Daneman N, Campitelli MA, Giannakeas V, et al.Influences on the start, selection and duration of treatment with antibiotics in long-term care facilities.CMAJ. 2017 Jun 26;189(25):E851-E860. doi: 10.1503/cmaj.161437.

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    2017-08-13 lhlxtx
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    2017-08-13 cathymary
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    2017-08-12 明天会更好!

    谢谢分享,学习了很好!

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