Diverticular disease management in primary care: How do estimates from community-dispensed antibiotics inform provision of care?

Abstract

Background The literature regarding diverticular disease of the intestines (DDI) almost entirely concerns hospital-based care; DDI managed in primary care settings is rarely addressed. Aim To estimate how often DDI is managed in primary care, using antibiotics dispensing data. Design and setting Hospitalisation records of New Zealand residents aged 30+ years during 2007–2016 were individually linked to databases of community-dispensed oral antibiotics. Method Patients with an index hospital admission 2007–2016 including a DDI diagnosis (ICD-10-AM = K57) were grouped by acute/non-acute hospitalisation. We compared use of guideline-recommended oral antibiotics for the period 2007–2016 for these people with ten individually-matched non-DDI residents, taking the case’s index date. Multivariable negative binomial models were used to estimate rates of antibiotic use. Results From almost 3.5 million eligible residents, data were extracted for 51,059 index cases (20,880 acute, 30,179 non-acute) and 510,581 matched controls; mean follow-up = 8.9 years. Dispensing rates rose gradually over time among controls, from 47 per 100 person-years (/100py) prior to the index date, to 60/100py after 3 months. In comparison, dispensing was significantly higher for those with DDI: for those with acute DDI, rates were 84/100py prior to the index date, 325/100py near the index date, and 141/100py after 3 months, while for those with non-acute DDI 75/100py, 108/100py and 99/100py respectively. Following an acute DDI admission, community-dispensed antibiotics were dispensed at more than twice the rate of their non-DDI counterparts for years, and were elevated even before the index DDI hospitalisation. Conclusion DDI patients experience high use of antibiotics. Evidence is needed that covers primary-care and informs self-management of recurrent, chronic or persistent DDI.

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ACUTE UNCOMPLICATED DIVERTICULITIS: Guidelines on Diagnosis and Management: is everything fine?

“…The result was that antibiotic use in primary care not only doubled over the years after an acute admission compared with controls but was also higher before admission. 85…”