■在过去的三十年中,瑞典的抗生素处方显着减少。对几年来影响抗生素处方的因素知之甚少。
■为了比较初级保健医生,随着时间的推移,对于那些在潜在影响因素方面保持高或低处方的人,他们减少了呼吸道感染的抗生素处方。
■一项基于注册的研究,包括Kronoberg地区初级保健的所有RTI就诊,瑞典2006-2014年。数据分为三个3年期。
■这些数据包括所有在三年期间诊断出至少一种RTI的医生。针对患者性别和年龄组调整后的抗生素处方率是针对每个医生和时期计算的,根据第一阶段和第三阶段之间的变化,医生分为三个处方组:高处方组,减少处方组,和低处方组。
■对于三个处方组,我们比较了影响抗生素处方的因素,如医生的特点,他们使用即时测试,他们选择的诊断,以及患者是否返回并接受抗生素治疗。
■高处方组订购了更多的护理点测试,记录了更多潜在的细菌诊断,在较低的C反应蛋白水平下处方抗生素,尽管A组链球菌试验阴性,但与低处方组相比,处方抗生素的频率更高。关于这些变量,递减处方组介于高处方组和低处方组之间。低处方组较低的处方率在30天内没有导致更多的复诊或新的抗生素处方。
■处方组之间的护理点测试及其解释有所不同。专注于解释即时检测结果可能是抗生素管理的一种方法。
高处方者在较低的CRP水平下使用抗生素,更有可能确定潜在的细菌诊断。在研究期间,许多医生减少了抗生素处方。十分之九的低处方者仍然是低处方者。看到低处方的医生不会导致更多的回诊或抗生素改变。
UNASSIGNED: There has been a notable decrease in antibiotic prescribing in the last thirty years in Sweden. Little is known about factors influencing antibiotic prescribing over several years.
UNASSIGNED: To compare primary care physicians who, over time, reduced their antibiotic prescribing for respiratory tract infections with those who remained either high or low prescribers regarding potentially influencing factors.
UNASSIGNED: A register-based study including all RTI visits in primary care in Region Kronoberg, Sweden 2006-2014. The data were divided into three 3-year periods.
UNASSIGNED: The data comprised all physicians who had diagnosed at least one RTI for each of the three-year periods. The antibiotic prescribing rate adjusted for the patients\' sex and age group was calculated for each physician and period, and based on the change between the first and the third period, the physicians were divided into three prescriber groups: The High Prescribing Group, the Decreasing Prescribing Group, and the Low Prescribing Group.
UNASSIGNED: For the three prescriber groups, we compared factors influencing antibiotic prescribing such as the characteristics of the physicians, their use of point-of-care tests, their choice of diagnoses, and whether the patients returned and received antibiotics.
UNASSIGNED: The High Prescribing Group ordered more point-of-care tests, registered more potential bacterial diagnoses, prescribed antibiotics at lower C-reactive protein levels, and prescribed antibiotics more often despite negative group A Streptococci test than in the Low Prescribing Group. The Decreasing Prescribing Group was between the High Prescribing Group and the Low Prescribing Group regarding these variables. The lower prescription rate in the Low Prescribing Group did not result in more return visits or new antibiotic prescriptions within 30 days.
UNASSIGNED: Point-of-care testing and its interpretation differed between the prescriber groups. Focus on interpreting point-of-care test results could be a way forward in antibiotic stewardship.
High prescribers used antibiotics at lower CRP levels and were more likely to identify a potential bacterial diagnosis.Many physicians reduced their antibiotic prescribing during the study period. Nine out of ten low prescribers remained low prescribers.Seeing a low-prescribing physician did not lead to more return visits or antibiotic changes.