Prevalence of antibiotic prescription in pediatric outpatients in Italy: the role of local health districts and primary care physicians in determining variation. A multilevel design for healthcare decision support

Autor: Danilo Fusco, Adele Lallo, Marina Davoli, Ursula Kirchmayer, Mirko Di Martino
Jazyk: angličtina
Rok vydání: 2017
Předmět:
Male
0301 basic medicine
medicine.medical_specialty
Pediatrics
Adolescent
Clinical Decision-Making
030106 microbiology
Drug Prescriptions
Physicians
Primary Care
03 medical and health sciences
Professional Role
0302 clinical medicine
Pharmacotherapy
Health care
Epidemiology
Geographic variation
Ambulatory Care
medicine
Humans
030212 general & internal medicine
Practice Patterns
Physicians'
Medical prescription
Child
Multilevel models
Local Government
business.industry
Public health
Incidence (epidemiology)
lcsh:Public aspects of medicine
Preschool children
Infant
Newborn
Public Health
Environmental and Occupational Health
Infant
lcsh:RA1-1270
Odds ratio
Pediatric outpatients
Middle Aged
Anti-Bacterial Agents
Italy
Child
Preschool
Emergency medicine
Multilevel Analysis
Female
Antibiotic prescription patterns
Biostatistics
business
Research Article
Zdroj: BMC Public Health, Vol 17, Iss 1, Pp 1-8 (2017)
BMC Public Health
ISSN: 1471-2458
DOI: 10.1186/s12889-017-4905-4
Popis: Background According to scientific literature, antibacterials are prescribed for common pediatric conditions that do not benefit from antibiotic therapy. The link between antibiotic use and bacterial resistance is well known. Antibiotic overprescribing generates high social costs and severe consequences for children. Our objectives were to analyze antibiotic prescription patterns in pediatric outpatients residing in the Lazio region (Italy), to identify physicians’ characteristics associated with increased propensity for prescription, to identify the priority axes for action to improve the rational use of antibiotics. Methods We enrolled all children aged 13 years or less in 2014. Antibiotic prescription patterns were analyzed during a one-year follow-up period. The main outcome measures were the antibiotic prescription prevalence, and the geographic variation in antibiotic prescribing. Multilevel models were performed to analyze variation. Variation was expressed as Median Odds Ratios (MORs). If the MOR is 1.00, there is no variation between clusters. If there is considerable between-cluster variation, the MOR will be large. Results We enrolled 636,911 children. Most of them were aged 6–13 years (57.3%). In 2015, the antibiotic prescription prevalence was 46% in the 0–13, 58% in the 0–5, and 37% in the 6–13 age group. Overall, penicillins were the most prescribed antibiotics, their consumption increased from 43% to 52% during the 2007–2015 period. In 2015, the antibiotic prescription prevalence ranged from 30% to 62% across local health districts (LHDs) of the region. Moreover, a significant (p
Databáze: OpenAIRE
Externí odkaz: