2018-2021年法国全国范围内直接面向消费者的远程医疗平台的儿科抗生素处方。

IF 3.7 Q2 INFECTIOUS DISEASES
JAC-Antimicrobial Resistance Pub Date : 2024-05-08 eCollection Date: 2024-06-01 DOI:10.1093/jacamr/dlae070
Bénédicte Melot, Elise Launay, Florian Drouet, Julie Salomon, Julie Toubiana, Julien Grosjean, Catherine Duclos, Jérémie F Cohen
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引用次数: 0

摘要

背景:最近的监管和报销变化促进了初级保健中远程会诊的发展。法国的指南建议不要在远程会诊中为儿童开具抗生素处方。我们对法国远程会诊平台上的儿科抗生素处方进行了评估:这项横断面观察性研究分析了2018年1月至2021年12月期间在全国直接面向消费者的远程会诊平台上的儿科(0-14岁)就诊情况。研究纳入了具有完整诊断信息(ICD-10 编码)和处方的远程会诊。我们评估了每 100 次就诊中不同诊断的抗生素处方率,并使用逻辑回归法确定了与抗生素处方相关的因素:在由 713 名全科医生(GP)和 89 名儿科医生进行的 37 587 次儿科远程会诊(中位年龄为 3 岁)中,12.1% 的会诊处方使用了抗生素。呼吸道感染(RTI)占抗生素处方的 49.5%。每 100 次就诊的抗生素处方率为:鼻窦炎 69.5%;泌尿道感染 62.2%;咽炎 59.0%;肺炎 45.5%;耳炎 46.6%;支气管炎 19.6%;鼻炎 11.6%;支气管炎 6.6%。全科医生的抗生素处方率高于儿科医生[OR 2.21(IC95% 2.07-2.35)],45-54 岁和 65 岁以上的医生[OR 分别为 1.66(1.48-1.85)和 1.48(1.32-1.分别为 1.66(1.48-1.85)和 1.48(1.32-1.66)]、女医生[OR 1.13(1.05-1.21)]、3-6 岁儿童[OR 1.41(1.28-1.56)]和 6 岁以上儿童[OR 1.50(1.35-1.66)]、冬季[OR 1.28(1.21-1.37)]和 RTI[OR 1.99(1.87-2.10)]。具有丰富远程会诊经验的医生的抗生素处方率较低[OR 0.92 (0.86-0.98)]:尽管目前有相关建议,但儿科患者在接受急诊远程会诊时仍经常被开具抗生素处方。应针对儿科远程会诊开展专门的抗生素管理活动。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Paediatric antibiotic prescribing in a nationwide direct-to-consumer telemedicine platform in France, 2018-2021.

Background: Recent regulatory and reimbursement changes facilitated the development of teleconsultation within primary care. French guidance advises against antibiotic prescribing in children in teleconsultation. We assessed paediatric antibiotic prescribing on a French teleconsultation platform.

Methods: This cross-sectional observational study analysed paediatric (0-14 years) visits on a national direct-to-consumer teleconsultation platform between January 2018 and December 2021. Teleconsultations with complete information regarding diagnosis (ICD-10 coding) and prescriptions were included. We assessed antibiotic prescription rates per 100 visits across diagnoses and used logistic regression to identify factors associated with antibiotic prescribing.

Results: In the 37 587 included paediatric teleconsultations (median age 3 years) performed by 713 general practitioners (GPs) and 89 paediatricians, antibiotics were prescribed for 12.1%. Respiratory tract infections (RTIs) accounted for 49.5% of antibiotic prescriptions. Antibiotic prescription rates per 100 visits were: sinusitis, 69.5%; urinary tract infections, 62.2%; pharyngitis, 59.0%; pneumonia, 45.5%; otitis, 46.6%; bronchitis, 19.6%; rhinitis, 11.6%; bronchiolitis 6.6%. Antibiotic prescription rates were higher in GPs than paediatricians [OR 2.21 (IC95% 2.07-2.35)], among physicians aged 45-54 and over 65 [OR 1.66 (1.48-1.85) and 1.48 (1.32-1.66), respectively], in female practitioners [OR 1.13 (1.05-1.21)], in children 3-6 years old [OR 1.41 (1.28-1.56)] and over 6 [OR 1.50 (1.35-1.66)], during winter [OR 1.28 (1.21-1.37)] and for RTIs [OR 1.99 (1.87-2.10)]. Antibiotic prescription rates were lower in doctors with extensive experience in teleconsultation [OR 0.92 (0.86-0.98)].

Conclusions: Despite current recommendations, paediatric patients were frequently prescribed antibiotics during acute care teleconsultations. Specific antibiotic stewardship campaigns should target paediatric teleconsultations.

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