Appropriateness of antibiotic prescribing in veterans with community-acquired pneumonia, sinusitis, or acute exacerbations of chronic bronchitis: A cross-sectional study

Tobia, Colleen Cook; Aspinall, Sherrie L.; Good, Chester B.; Fine, Michael J.; Hanlon, Joseph T.

doi:10.1016/j.clinthera.2008.06.009

Cited by 22 publications

(28 citation statements)

References 32 publications

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“…Other studies in China have shown that antibiotic prescribing and use was connected with the interaction between physicians and patients [15,19]. A study in Pakistan and other studies have also demonstrated irrational prescribing of injections and antibiotics [3,20,21]. …”

Section: Discussionmentioning

confidence: 99%

Provider performance in treating poor patients - factors influencing prescribing practices in lao PDR: a cross-sectional study

Syhakhang

Soukaloun

Tomson

et al. 2011

BMC Health Serv Res

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BackgroundOut-of-pocket payments make up about 80% of medical care spending at hospitals in Laos, thereby putting poor households at risk of catastrophic health expenditure. Social security schemes in the form of community-based health insurance and health equity funds have been introduced in some parts of the country. Drug and Therapeutics Committees (DTCs) have been established to ensure rational use of drugs and improve quality of care. The objective was to assess the appropriateness and expenditure for treatment for poor patients by health care providers at hospitals in three selected provinces of Laos and to explore associated factors.MethodsCross-sectional study using four tracer conditions. Structured interviews with 828 in-patients at twelve provincial and district hospitals on the subject of insurance protection, income and expenditures for treatment, including informal payment. Evaluation of each patient's medical record for appropriateness of drug use using a checklist of treatment guidelines (maximum score = 10).ResultsNo significant difference in appropriateness of care for patients at different income levels, but higher expenditures for patients with the highest income level. The score for appropriate drug use in insured patients was significantly higher than uninsured patients (5.9 vs. 4.9), and the length of stay in days significantly shorter (2.7 vs. 3.7). Insured patients paid significantly less than uninsured patients, both for medicines (USD 14.8 vs. 43.9) and diagnostic tests (USD 5.9 vs. 9.2). On the contrary the score for appropriateness of drug use in patients making informal payments was significantly lower than patients not making informal payments (3.5 vs. 5.1), and the length of stay significantly longer (6.8 vs. 3.2), while expenditures were significantly higher both for medicines (USD 124.5 vs. 28.8) and diagnostic tests (USD 14.1 vs. 7.7).ConclusionsThe lower expenditure for insured patients can help reduce the number of households experiencing catastrophic health expenditure. The positive effects of insurance schemes on expenditure and appropriate use of medicines may be associated with the long-term effects of promoting rational use of drugs, including support to active DTC work.

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Section: Discussionmentioning

confidence: 99%

Provider performance in treating poor patients - factors influencing prescribing practices in lao PDR: a cross-sectional study

Syhakhang

Soukaloun

Tomson

et al. 2011

BMC Health Serv Res

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“…Appropriateness was measured using the Medication Appropriateness Index (MAI) [ 12 ]. The MAI is a validated tool that assesses the appropriateness of 10 different areas of medication prescribing: indication, effectiveness, dosage (based on indication and renal function), directions, practicality, drug–drug interactions, drug–disease interactions, duplication, duration, and expense [ 13 , 14 ]. For every prescribed medication, the reviewers answered each of the 10 questions in the MAI with either A (appropriate), B (not clearly appropriate), or C (inappropriate).…”

Section: Methodsmentioning

confidence: 99%

Assessments of Opportunities to Improve Antibiotic Prescribing in an Emergency Department: A Period Prevalence Survey

et al. 2017

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IntroductionApproximately 30% of all outpatient antimicrobials are inappropriately prescribed. Currently, antimicrobial prescribing patterns in emergency departments (ED) are not well described. Determining inappropriate antimicrobial prescribing patterns and opportunities for interventions by antimicrobial stewardship programs (ASP) are needed.MethodsA retrospective chart review was performed among a random sample of non-admitted, adult patients who received an antimicrobial prescription in the ED from January 1 to December 31, 2015. Appropriateness was measured using the Medication Appropriateness Index, and was based on provider adherence to local guidelines. Additional information collected included patient characteristics, initial diagnoses, and other chronic medication use.ResultsOf 1579 ED antibiotic prescriptions in 2015, we reviewed a total of 159 (10.1%) prescription records. The most frequently prescribed antimicrobial classes included penicillins (22.6%), macrolides (20.8%), cephalosporins (17.6%), and fluoroquinolones (17.0%). The most common indications for antibiotics were bronchitis or upper respiratory tract infection (URTI) (35.1%), followed by skin and soft tissue infection (SSTI) (25.0%), both of which were the most common reason for unnecessary prescribing (28.9% of bronchitis/URTIs, 25.6% of SSTIs). Of the antimicrobial prescriptions reviewed, 39% met criteria for inappropriateness. Among 78 prescriptions with a consensus on appropriate indications, 13.8% had inappropriate dosing, duration, or expense.ConclusionConsistent with national outpatient prescribing, inappropriate antibiotic prescribing in the ED occurred in 39% of cases with the highest rates observed among patients with bronchitis, URTI, and SSTI. Antimicrobial stewardship programs may benefit by focusing on initiatives for these conditions among ED patients. Moreover, creation of local guideline pocketbooks for these and other conditions may serve to improve prescribing practices and meet the Core Elements of Outpatient Stewardship recommended by the Centers for Disease Control and Prevention.

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“…Another matter of concern is of prescribed antibiotic [26][27][28][29]. This has serious consequences: exposing the patients to adverse effects, increase of number of visits for mild issues [14,26,30], and development of resistant bacterium strains [14,31].…”

Section: Introductionmentioning

confidence: 99%

Prescribing Patterns for Acute Respiratory Infections in Children in Primary Health Care Centers, Makkah Al Mukarramah, Saudi Arabia

Shaheen

Siddiqui

Jokhdar

et al. 2018

JEGH

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Acute respiratory infections (ARI) are a major public health problem and one of the commonest reasons for visiting primary health care centers (PHC). In developing countries, seventy-five percent of the cases are treated with antibiotics, although the majority are caused by viral infection. Our aim was to observe the pattern of physician practices with respect to ARI, in comparison to WHO protocols and to provide recommendations for health promotion enhancement. The study was conducted in Makkah PHC centers, for 2 months. A total 14 PHC centers were randomly selected. And 908 prescriptions were obtained randomly from general practitioners (GP) and analyzed. We found that males were 522 and females were and 386. Weights were not recorded in 224 (24.7%) cases. In 87 cases (9.6%) no diagnosis was recorded. In 515 (62.34%) of cases, antibiotics were prescribed; most of these cases were of simple common cold, with antibiotics not recommended. To conclude, many physicians in Makkah are not following the WHO guidelines for Acute Respiratory Infection. Educational health programs should be conducted to sensitize the physicians regarding the appropriate method of diagnosis and rational use of antibiotics.

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Appropriateness of antibiotic prescribing in veterans with community-acquired pneumonia, sinusitis, or acute exacerbations of chronic bronchitis: A cross-sectional study

Abstract: Background-Previous studies evaluating antibiotic appropriateness in bacterial respiratory tract infections have focused only antibiotic choice and ignored other important aspects of prescribing such as dosing, drug-drug interactions, and duration of therapy.

Cited by 22 publications

References 32 publications

Provider performance in treating poor patients - factors influencing prescribing practices in lao PDR: a cross-sectional study

Provider performance in treating poor patients - factors influencing prescribing practices in lao PDR: a cross-sectional study

Assessments of Opportunities to Improve Antibiotic Prescribing in an Emergency Department: A Period Prevalence Survey

Prescribing Patterns for Acute Respiratory Infections in Children in Primary Health Care Centers, Makkah Al Mukarramah, Saudi Arabia

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