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

• 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
• 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

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) 是患者在美国寻求治疗的最常见原因，占所有抗生素处方的大部分。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增加。减少 ARI 抗生素处方的干预措施收效有限，这凸显了了解导致不当处方的因素的必要性。我们认为，原因因环境和提供商类型而异。这一点很重要，因为患者接受 ARI 护理的地点正在不断转变，从医生转向执业护士，从门诊诊所转向零售诊所。 零售诊所是指位于药店和杂货店的诊所，为急性呼吸道感染者提供上门护理服务。 一些人担心这种护理方式的转变会加剧急性呼吸道感染的不适当抗生素处方；其他人认为这种转变将改善抗生素处方。 先前关于该主题的研究有限。在这项探索性研究中，有两个目标。在目标 1 中，我们将研究这种护理方式的转变是否会恶化或改善 ARI 抗生素处方。我们将使用国家数据源来衡量门诊办公室和零售诊所的医生和执业护士为急性呼吸道感染开出的抗生素处方。在目标 2 中，我们将开展一项调查，可用于更好地了解导致不同护理场所抗生素处方不当的因素。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，以及 (b) 检查哪些因素导致抗生素处方的变化。我们将通过比较小插图测量的抗生素处方质量与图表测量的抗生素处方质量来验证该调查。 这两个目标的结果将为对全国提供者样本进行更大规模的研究奠定基础，以了解哪些因素导致抗生素处方的变化。第一个目标的结果可能会凸显提供者和护理站点之间的重要质量差异。第二个目标将支持开发经过验证的小插曲调查，该调查可用于检查导致跨护理场所、地理区域和提供者类型不适当抗生素处方的因素。我们希望，未来的工作将带来有针对性和量身定制的干预措施，以最大限度地减少不适当的抗生素处方。 这项研究是针对新主题的首批研究之一，可能会在对 ARI 不适当的抗生素处方这一具有明显公共卫生重要性的问题上带来重大突破。 公共卫生相关性：先前的研究表明，对于鼻窦炎或喉咙痛等急性呼吸道疾病，抗生素的使用过于频繁。现在，越来越多的患者在门诊办公室和零售诊所接受执业护士的急性呼吸道疾病护理，一些人担心这会增加服用不当抗生素的患者数量。在这项研究中，我们将看看情况是否如此。我们还将开展一项调查，可用于研究提供者不恰当地开出抗生素的原因。这项工作将来可用于定制干预措施，以改善抗生素处方。