prescription rates
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Author(s):  
Signe Benzon Larsen ◽  
Christian Dehlendorff ◽  
Charlotte Skriver ◽  
Anton Pottegård ◽  
Søren Friis ◽  
...  

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0259065
Author(s):  
Yue Chang ◽  
Yuanfan Yao ◽  
Zhezhe Cui ◽  
Guanghong Yang ◽  
Duan Li ◽  
...  

Background The overuse and abuse of antibiotics is a major risk factor for antibiotic resistance in primary care settings of China. In this study, the effectiveness of an automatically-presented, privacy-protecting, computer information technology (IT)-based antibiotic feedback intervention will be evaluated to determine whether it can reduce antibiotic prescribing rates and unreasonable prescribing behaviours. Methods We will pilot and develop a cluster-randomised, open controlled, crossover, superiority trial. A total of 320 outpatient physicians in 6 counties of Guizhou province who met the standard will be randomly divided into intervention group and control group with a primary care hospital being the unit of cluster allocation. In the intervention group, the three components of the feedback intervention included: 1. Artificial intelligence (AI)-based real-time warnings of improper antibiotic use; 2. Pop-up windows of antibiotic prescription rate ranking; 3. Distribution of educational manuals. In the control group, no form of intervention will be provided. The trial will last for 6 months and will be divided into two phases of three months each. The two groups will crossover after 3 months. The primary outcome is the 10-day antibiotic prescription rate of physicians. The secondary outcome is the rational use of antibiotic prescriptions. The acceptability and feasibility of this feedback intervention study will be evaluated using both qualitative and quantitative assessment methods. Discussion This study will overcome limitations of our previous study, which only focused on reducing antibiotic prescription rates. AI techniques and an educational intervention will be used in this study to effectively reduce antibiotic prescription rates and antibiotic irregularities. This study will also provide new ideas and approaches for further research in this area. Trial registration ISRCTN, ID: ISRCTN13817256. Registered on 11 January 2020.


Author(s):  
Tal Marom ◽  
Jacob Pitaro ◽  
Udayan K. Shah ◽  
Sara Torretta ◽  
Paola Marchisio ◽  
...  

The global coronavirus disease-2019 (COVID-19) pandemic has changed the prevalence and management of many pediatric infectious diseases, including acute otitis media (AOM). Coronaviruses are a group of RNA viruses that cause respiratory tract infections in humans. Before the COVID-19 pandemic, coronavirus serotypes OC43, 229E, HKU1, and NL63 were infrequently detected in middle ear fluid (MEF) specimens and nasopharyngeal aspirates in children with AOM during the 1990s and 2000s and were associated with a mild course of the disease. At times when CoV was detected in OM cases, the overall viral load was relatively low. The new severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the causative pathogen responsible for the eruption of the COVID-19 global pandemic. Following the pandemic declaration in many countries and by the World Health Organization in March 2020, preventive proactive measures were imposed to limit COVID-19. These included social distancing; lockdowns; closure of workplaces; kindergartens and schools; increased hygiene; use of antiseptics and alcohol-based gels; frequent temperature measurements and wearing masks. These measures were not the only ones taken, as hospitals and clinics tried to minimize treating non-urgent medical referrals such as OM, and elective surgical procedures were canceled, such as ventilating tube insertion (VTI). These changes and regulations altered the way OM is practiced during the COVID-19 pandemic. Advents in technology allowed a vast use of telemedicine technologies for OM, however, the accuracy of AOM diagnosis in those encounters was in doubt, and antibiotic prescription rates were still reported to be high. There was an overall decrease in AOM episodes and admissions rates and with high spontaneous resolution rates of MEF in children, and a reduction in VTI surgeries. Despite an initial fear regarding viral shedding during myringotomy, the procedure was shown to be safe. Special draping techniques for otologic surgery were suggested. Other aspects of OM practice included the presentation of adult patients with AOM who tested positive for SARS-2-CoV and its detection in MEF samples in living patients and in the mucosa of the middle ear and mastoid in post-mortem specimens.


2022 ◽  
Vol 226 (1) ◽  
pp. S749
Author(s):  
Natasha R. Kumar ◽  
Sedona Speedy ◽  
Jing Song ◽  
Leah Welty ◽  
Arjeme D. Cavens

Antibiotics ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 18
Author(s):  
Elisa Barbieri ◽  
Costanza di Chiara ◽  
Paola Costenaro ◽  
Anna Cantarutti ◽  
Carlo Giaquinto ◽  
...  

Comprehensive data are needed to monitor antibiotic prescribing and inform stewardship. We aimed to evaluate the current antibiotic prescribing patterns, including treatment switching and prolongation, in the paediatric primary care setting in Italy. This database study assessed antibiotic prescriptions retrieved from Pedianet, a paediatric primary care database, from 1 January 2012 to 31 December 2018. Descriptive analyses were stratified by diagnosis class, calendar year, and children’s age. Generalized linear Poisson regression was used to assess variation in the prescriptions. In total, 505,927 antibiotic prescriptions were included. From 2012 to 2018, the number of antibiotics per child decreased significantly by 4% yearly from 0.79 in 2012 to 0.62 in 2018. Amoxicillin prescriptions decreased with increasing children’s age, while macrolides and third-generation cephalosporins had the opposite trend. Prescriptions were associated with a diagnosis of upper respiratory infection in 23% of cases, followed by pharyngitis (21%), bronchitis and bronchiolitis (12%), and acute otitis media (12%). Eight percent of treatment episodes were prolonged or switched class, mostly represented by co-amoxiclav, macrolides, and third-generation cephalosporins. Our findings report an overall decrease in antibiotic prescriptions, but pre-schoolers are still receiving more than one antibiotic yearly, and broad-spectrum antibiotics prescription rates remain the highest.


2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Nancy Xurui Huang ◽  
John E. Sanderson ◽  
Fang Fang ◽  
Cheuk-Man Yu ◽  
Bryan P. Yan

Secondary prevention therapy reduces death and reinfarction after acute myocardial infarction (AMI), but it is underutilized in clinical practice. Mechanisms for this therapeutic gap are not well established. In this study, we have explored and evaluated the impact of passive continuation compared to active initiation of secondary prevention therapy for AMI during the index hospitalization. For this purpose, we have analyzed 1083 consecutive patients with AMI to a tertiary referral hospital in Hong Kong and assessed discharge prescription rates of secondary prevention therapies (aspirin, beta-blockers, statins, and ACEI/ARBs). Multivariate analysis was used to identify independent predictors of discharge medication, and Kaplan–Meier survival curve was used to evaluate 12-month survival. Overall, prescription rates of aspirin, beta-blocker, statin, and ACEI/ARBs on discharge were 94.8%, 64.5%, 83.5%, and 61.4%, respectively. Multivariate analysis showed that prior use of each therapy was an independent predictor of prescription of the same therapy on discharge: aspirin (odds ratio (OR) = 4.8, 95% CI = 1.9–12.3, P < 0.01 ), beta-blocker (OR = 2.5, 95% CI = 1.8–3.4, P < 0.01 ); statin (OR = 8.3, 95% CI = 0.4–15.7, P < 0.01 ), and ACEI/ARBs (OR = 2.9, 95% CI = 2.0–4.3, P < 0.01 ). Passive continuation of prior medication was associated with higher 1-year mortality rates than active initiation in treatment-naïve patients (aspirin (13.7% vs. 5.7%), beta-blockers (12.9% vs. 5.6%), and statins (11.0% vs. 4.6%); all P < 0.01 ). Overall, the use of secondary prevention medication for AMI was suboptimal. Our findings suggested that the practice of passive continuation of prior medication was prevalent and associated with adverse clinical outcomes compared to active initiation of secondary preventive therapies for acute myocardial infarction during the index hospitalization.


2021 ◽  
Author(s):  
Misa Takahashi ◽  
Hideharu Hagiya ◽  
Tsukasa Higashionna ◽  
Yasuhiro Nakano ◽  
Kota Sato ◽  
...  

Abstract To promote antimicrobial stewardship (AMS) and appropriate antibiotic use, we studied antimicrobial prescription rates for uncomplicated cystitis, a common outpatient disease requiring antibiotic treatment in Japan. This multicenter retrospective study was performed from January 1, 2018, to December 31, 2020, targeting outpatients aged ≥20 years whose medical records revealed International Classification of Diseases (ICD-10) codes suggesting uncomplicated cystitis (N300). We divided eligible cases into two age groups (20–49 years and ≥50 years) and defined broad-spectrum antimicrobials as fluoroquinolones, third-generation cephalosporins, and faropenem. Primary and secondary outcomes were defined as the prescription rates of broad-spectrum antimicrobials for the disease and the association of antimicrobial types with recurrence. The data of 1,445 patients were collected and that of 902 patients were analyzed. The overall proportion of broad-spectrum antimicrobial prescriptions was 69.1%. The broad-spectrum agents were prescribed frequently in the older group, male patients, and internal medicine. Recurrence was observed in 37 (4.1%) cases, and age, sex, or antimicrobial types were not associated with the recurrence. Hence, approximately two-thirds of antimicrobials prescribed for uncomplicated cystitis were broad-spectrum agents. Administration of broad-spectrum antimicrobials was not associated with the prevention of the recurrence of cystitis.


Author(s):  
Péter Csonka ◽  
Paula Heikkilä ◽  
Sonja Koskela ◽  
Sauli Palmu ◽  
Noora Lajunen ◽  
...  

AbstractOur aim was to construct and test an intervention programme to eradicate cough and cold medicine (CCM) prescriptions for children treated in a nationwide healthcare service company. The study was carried out in the largest private healthcare service company in Finland with a centralised electronic health record system allowing for real-time, doctor-specific practice monitoring. The step-by-step intervention consisted of company-level dissemination of educational materials to doctors and families, educational staff meetings, continuous monitoring of prescriptions, and targeted feedback. Outreach visits were held in noncompliant units. Finally, those physicians who most often prescribed CCM were directly contacted. During the intervention period (2017–2020), there were more than one million paediatric visits. Prescriptions of CCMs to children were completely eradicated in 41% of units and the total number of CCM prescriptions decreased from 6738 to 744 (89%). During the fourth intervention year, CCMs containing opioid derivatives were prescribed for only 0.2% of children aged < 2 years. The decrease in prescriptions was greatest in general practitioners (5.2 to 1.1%). In paediatricians, the prescription rates decreased from 1.5 to 0.2%. The annual costs of CCMs decreased from €183,996 to €18,899 (89.7%). For the intervention, the developers used 343 h and the attended doctors used 684 h of work time during the 4-year intervention. The costs used for developing, implementing, reporting, evaluating, communicating, and data managing formed approximately 11% of total intervention costs.Conclusion: The study showed that a nationwide systematic intervention to change cough medicine prescription practices is feasible and requires only modest financial investments. What is Known:• Cough and cold medicines (CCM) are not effective or safe, especially for children aged 6 years.• Although the use of CCMs has been declining, caregivers continue to administer CCMs to children, and some physicians still prescribe them even for preschool children. What is New:• A nationwide systematic intervention can significantly and cost effectively change CCM prescription habits of paediatricians, general practitioners, and other specialists.• Electronic health records provide additional tools for operative guideline implementation and real-time quality monitoring, including recommendations of useless or harmful treatments.


2021 ◽  
Author(s):  
Shaffi Fazaludeen Koya ◽  
Habib Hasan Farooqui ◽  
Aashna Mehta ◽  
Sakthivel Selvaraj ◽  
Sandro Galea

Background India's typhoid burden estimates are based on a limited number of population-based studies and data from a grossly incomplete disease surveillance system. In this study, we estimated the total and sex-and age-specific antibiotic prescription rates for typhoid. Methods We used systematic antibiotic prescription by private sector primary care physicians in India. We categorized antibiotics using the WHO classification system and calculated the prescription for various classes of antibiotics. Results We analyzed 671 million prescriptions for the three-year period (2013-2015), of which an average of 8.98 million antibiotic prescriptions per year was for typhoid, accounting for 714 prescriptions per 100,000 population. Combination antibiotics are the preferred choice of prescribers in the adult age group, while cephalosporins are the preferred choice in children and young age. The prescription rate decreased from 792/100,000 in 2013 to 635 in 2015. Conclusion We report a higher rate of antibiotic prescription for typhoid using prescription data, indicating a higher disease burden than previously estimated. Quinolones are still widely used in monotherapy, and children less than 10 years account for more than a million cases annually, which calls for a routine vaccination program.


Antibiotics ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 1521
Author(s):  
Josi A. Boeijen ◽  
Alike W. van der Velden ◽  
Saskia Hullegie ◽  
Tamara N. Platteel ◽  
Dorien L. M. Zwart ◽  
...  

Presentation and antibiotic prescribing for common infectious disease episodes decreased substantially during the first COVID-19 pandemic wave in Dutch general practice. We set out to determine the course of these variables during the first pandemic year. We conducted a retrospective observational cohort study using routine health care data from the Julius General Practitioners’ Network. All patients registered in the pre-pandemic year (n = 425,129) and/or during the first pandemic year (n = 432,122) were included. Relative risks for the number of infectious disease episodes (respiratory tract/ear, urinary tract, gastrointestinal, and skin), in total and those treated with antibiotics, and proportions of episodes treated with antibiotics (prescription rates) were calculated. Compared to the pre-pandemic year, primary care presentation for common infections remained lower during the full first pandemic year (RR, 0.77; CI, 0.76–0.78), mainly attributed to a sustained decline in respiratory tract/ear and gastrointestinal infection episodes. Presentation for urinary tract and skin infection episodes declined during the first wave, but returned to pre-pandemic levels during the second and start of the third wave. Antibiotic prescription rates were lower during the full first pandemic year (24%) as compared to the pre-pandemic year (28%), mainly attributed to a 10% lower prescription rate for respiratory tract/ear infections; the latter was not accompanied by an increase in complications. The decline in primary care presentation for common infections during the full first COVID-19 pandemic year, together with lower prescription rates for respiratory tract/ear infections, resulted in a substantial reduction in antibiotic prescribing in Dutch primary care.


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