利用德国医疗保险基金的常规数据,得出门诊治疗上呼吸道感染的抗生素处方率。

IF 0.7 4区 医学 Q4 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Birgit Arens, Helmut L'Hoest, Alissa Wolf, Beata Hennig, Ursula Marschall, Irit Nachtigall
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引用次数: 0

摘要

背景:急性无并发症上呼吸道感染(RTI)是门诊中开具抗生素处方的常见原因,但其中 90% 以上是病毒性感染,且多为自限性感染。与其他欧洲国家相比,德国的抗生素处方率较低,但也存在地区差异。欧洲抗菌药物消费监控网络(ESAC-Net)针对特定疾病制定了质量指标(QI),以解决普通医生人群中的处方率问题(目标值为 80%)。本次分析的目的是利用一家医疗保险公司提供的二级数据,在疾病和医疗机构层面对 ESAC-Net-QI 进行操作,并分析有待改进的领域:基础数据库包括巴莫医疗保险公司 2022 年根据德国法律(§§ 295、300 和 301 SGB V)提供的医生账单、医院和处方数据。分类特征以频率和百分比表示。为了达到最大的特异性,我们排除了可能存在风险的病程:结果:在应用纳入和排除标准之前,2022 年抗生素的总体 RTI 处方率为 25%(1,197,568/4,720,786)。应用该算法后,所有 RTI 病例的处方率降至 6%(80,786/1,365,646)。如果考虑到特定的 RTI 适应症,急性支气管炎和急性鼻窦炎病例(4971/14051 例)中分别有 35% (13465/38913 例)获得了抗生素处方。在医疗机构层面,38%(1,396/3,705)治疗急性支气管炎的医疗机构和 41%(539/1,300)治疗急性鼻窦炎的医疗机构达到了抗生素处方的目标:我们的分析表明,可以利用常规医疗保险数据在病例和设施层面计算出针对 RTI 的 ESAC-Net-QI 值。对于特定的 RTIs,有迹象表明在处方抗生素的频率和选择方面存在改进潜力。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Antibiotic Prescription Rates For Respiratory Tract Infections Treated In The Outpatient Sector Based On Routine Data From A German Health Insurance Company].

Background: Acute uncomplicated upper respiratory tract infections (RTIs) are common reasons for antibiotic prescriptions in the outpatient sector, although>90% are of viral origins and mostly self-limiting. Germany has a low antibiotic prescription rate compared to other European countries, but there are regional differences. Disease-specific quality indicators (QI) developed by the European Surveillance of Antimicrobial Consumption Network (ESAC-Net) address the prescription rates (target <20%) and choice of antibiotic (target>80%) in a general practitioner population. The aim of this analysis was to operationalise the ESAC-Net-QI using secondary data from a health insurance company at the level of diseases and healthcare facilities, as well as to analyse areas for improvement.

Method: The underlying database comprises the panel physician billing, hospital and prescription data in accordance with German law (§§ 295, 300 and 301 SGB V) of the Barmer health insurance company for the year 2022. Categorical features are presented as frequency and percentage. Maximum specificity was aimed, hence potentially risky disease courses were excluded.

Results: The overall RTI prescription rate of antibiotics was 25% in 2022 before applying inclusion and exclusion criteria (1,197,568/4,720,786). After applying the algorithm, the prescription rate for all RTI cases dropped to 6% (80,786/1,365,646). When specific RTI indications are considered, 35% (13,465/38,913) of acute bronchitis and acute sinusitis cases (4,971/14,051) received an antibiotic prescription each. At the facility level, 38% of practices (1,396/3,705) treating acute bronchitis and 41% of practices (539/1,300) treating acute sinusitis achieved the target of<20% antibiotic prescriptions. Only 29% of all RTI cases with antibiotic prescriptions (23,733/80,786) received a first-choice antibiotic.

Conclusion: Our analysis indicates that the ESAC-Net-QI for RTIs can be calculated at case and facility levels using routine health insurance data. For specific RTIs, there were indications of improvement potential in the frequency and selection of prescribed antibiotics.

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来源期刊
Gesundheitswesen
Gesundheitswesen PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
CiteScore
1.90
自引率
18.20%
发文量
308
期刊介绍: The health service informs you comprehensively and up-to-date about the most important topics of the health care system. In addition to guidelines, overviews and comments, you will find current research results and contributions to CME-certified continuing education and training. The journal offers a scientific discussion forum and a platform for communications from professional societies. The content quality is ensured by a publisher body, the expert advisory board and other experts in the peer review process.
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