Antibiotic Prescribing for Acute Respiratory Infections: Impact of Shifts in Care

急性呼吸道感染的抗生素处方：护理转变的影响

基本信息

批准号：
8227713
负责人：
Ateev Mehrotra
金额：
$ 24.29万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-03-01 至 2014-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8227713
关键词：
Accounting Acute Acute respiratory infection Adult Antibiotic Resistance Antibiotics Area Automobile Driving Behavior Caring Childhood Clinic Clinic Visits Clinical Data Data Sources Development Effectiveness Electronic Health Record Family Physicians Foundations Future Geographic Locations Guidelines Health Care Costs Hospitals Intervention Intervention Trial Lead Measures Medical Modeling Nurse Practitioners Outpatients Patients Pattern Pharmaceutical Preparations Pharmacy facility Pharyngitis Physicians Primary Health Care Provider Public Health Quality of Care Research Respiratory Tract Infections Sampling Sinusitis Site Sore Throat Surveys Testing Uncertainty United States Variant Visit Walking Work care seeking comparison group effective intervention evidence based guidelines financial incentive improved innovation member novel respiratory rhinosinusitis success tool validation studies

Accounting Acute Acute respiratory infection Adult Antibiotic Resistance Antibiotics Area Automobile Driving Behavior Caring Childhood Clinic Clinic Visits Clinical Data Data Sources Development Effectiveness Electronic Health Record Family Physicians Foundations Future Geographic Locations Guidelines Health Care Costs Hospitals Intervention Intervention Trial Lead Measures Medical Modeling Nurse Practitioners Outpatients Patients Pattern Pharmaceutical Preparations Pharmacy facility Pharyngitis Physicians Primary Health Care Provider Public Health Quality of Care Research Respiratory Tract Infections Sampling Sinusitis Site Sore Throat Surveys Testing Uncertainty United States Variant Visit Walking Work care seeking comparison group effective intervention evidence based guidelines financial incentive improved innovation member novel respiratory rhinosinusitis success tool validation studies

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项目摘要

DESCRIPTION (provided by applicant): Acute respiratory tract infections (ARIs) are the most common reason patients seek care in the United States and account for the majority of all antibiotic prescriptions. A large fraction of these prescriptions are inappropriate resulting in increased antibiotic resistance, unnecessary drug complications, and increased health care costs. Interventions to decrease ARI antibiotic prescribing have had limited success, highlighting the need to understand the factors that drive inappropriate prescribing. We believe that the reasons vary across settings and by type of provider. This is important because there is an ongoing shift in where patients receive care for ARIs from physicians to nurse practitioners and from outpatient practices to retail clinics. Retail clinics are clinics in drug stores and grocery stores that provide walk-in care for ARIs. Some have expressed concern that this shift in care will worsen inappropriate antibiotic prescribing for ARIs; others believe this shift will improve antibiotic prescribing. There has been limited prior research on this topic. In this exploratory study, there are two aims. In Aim 1, we will study whether this shift in care worsens or improves ARI antibiotic prescribing. Using national data sources we will measure antibiotic prescribing for ARIs by physicians and nurse practitioners at outpatient offices and retail clinics. In Aim 2, we will develop a survey that can be used to better understand the factors driving inappropriate antibiotic prescribing at different care sites. We will pilot test and validate an ARI provider survey that (a) uses clinical vignettes to judge the quality of antibiotic prescribing and (b) examines what factors drive the variation in antibiotic prescribing. We will validate the survey by comparing vignette- measured antibiotic prescribing quality to chart-measured antibiotic prescribing quality. Together the results of the two aims will provide the foundation for a larger study of a national sample of providers to see what factors drive variation in antibiotic prescribing. The results of the first aim may highlight important quality differences across providers and care sites. The second aim will support the development of a validated vignette survey, which can be used to examine factors that drive inappropriate antibiotic prescribing across care sites, geographic regions, and provider types. Our hope is that this future work will lead to targeted and tailored interventions to minimize inappropriate antibiotic prescribing. The study represents one of the first studies on a novel topic and might lead to important breakthroughs on an issue of clear public health importance, inappropriate antibiotic prescribing for ARIs. PUBLIC HEALTH RELEVANCE: Prior research has shown that antibiotics are prescribed too often for acute respiratory illnesses such as sinusitis or sore throat. More patients are now receiving care for acute respiratory illnesses from nurse practitioners at outpatient offices and retail clinics and some are worried that this will increase the number of patients who are inappropriately prescribed antibiotics. In this study we will see if this is the case. We will also develop a survey that can be used to study why providers inappropriately prescribe antibiotics. The work can be used in the future to tailor interventions to improve antibiotic prescribing.

描述（由申请人提供）：急性呼吸道感染（ARIS）是患者在美国寻求护理的最常见原因，并说明了所有抗生素处方中的大部分。这些处方中很大一部分是不适当的，导致抗生素耐药性增加，不必要的药物并发症以及医疗保健成本的增加。减少ARI抗生素处方的干预措施取得了有限的成功，强调了了解驱动不适当处方的因素的必要性。我们认为，原因在各种设置和提供商的类型之间有所不同。这很重要，因为患者从医生到护士从业人员以及从门诊实践到零售诊所的ARIS护理的情况正在进行中。零售诊所是药物商店和杂货店的诊所，可为ARIS提供步入式护理。有些人表示担心，这种护理转变会恶化对Aris的不适当的抗生素处方。其他人则认为这种转变将改善抗生素处方。关于此主题的先前研究有限。在这项探索性研究中，有两个目标。在AIM 1中，我们将研究这种护理的转变是否恶化或改善ARI抗生素处方。使用国家数据来源，我们将在门诊办公室和零售诊所的医生和护士从业人员为ARIS的抗生素处方。在AIM 2中，我们将开发一项调查，该调查可用于更好地了解在不同护理场所推动不适当的抗生素处方的因素。我们将试点测试并验证ARI提供者调查，该调查（a）使用临床小插曲来判断抗生素处方的质量，并检查哪些因素驱动抗生素处方的变化。我们将通过比较小插图测得的抗生素处方质量与图表测量的抗生素处方质量来验证调查。这两个目标的结果共同为全国提供者样本的大量研究奠定了基础，以查看哪些因素促进了抗生素处方的变化。第一个目标的结果可能会突出提供者和护理网站之间的重要质量差异。第二个目的将支持经过验证的小插图调查的开发，该调查可用于检查驱动不适当的抗生素处方的因素，该因素在护理站点，地理区域和提供商类型之间。我们希望这项未来的工作将导致针对性和量身定制的干预措施，以最大程度地减少不适当的抗生素处方。该研究是关于新主题的第一批研究之一，可能会导致关于公共健康重要性，不适当的抗生素处方的重要突破。公共卫生相关性：先前的研究表明，对于急性呼吸道疾病（如鼻窦炎或喉咙痛），抗生素经常开处方。现在，越来越多的患者正在接受门诊办公室和零售诊所的护士从业者的急性呼吸道疾病的护理，有些患者担心这会增加不恰当的处方抗生素的患者数量。在这项研究中，我们将看到这种情况。我们还将开发一项调查，该调查可用于研究为什么提供者不适当地开抗生素。将来可以使用这项工作来调整干预措施以改善抗生素处方。