全科抗生素处方合理性的替代指标选择:法国全国共识程序。

IF 3.7 Q2 INFECTIOUS DISEASES JAC-Antimicrobial Resistance Pub Date : 2024-04-16 eCollection Date: 2024-04-01 DOI:10.1093/jacamr/dlae059
Maïa Simon, Aurélie Bocquier, Ouarda Pereira, Alexandre Charmillon, Damien Gonthier, Florence Lieutier Colas, Camille Vallance, Adeline Welter, Céline Pulcini, Nathalie Thilly
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引用次数: 0

摘要

背景:在法国,70%以上的门诊抗生素处方由全科医生开具。指标是抗生素管理的重要工具,可用于设定改进目标,并向专业人员和利益相关者提供反馈:本研究的主要目的是根据之前开发的 10 个替代指标(PIs)选择一套替代指标,以评估全科医生开具抗生素处方的适当性。次要目标是评估所选替代指标的临床特性:方法:由多学科利益相关者组成的小组采用兰德改进的德尔菲共识程序。该程序包括两次连续的在线调查,中间举行一次共识会议。利用 2022 年地区健康保险数据,对通过共识程序选出的 PI 进行了临床特性(可测量性、适用性和潜在改进空间)评估:结果:17 名专家参加了第一轮调查,14 名专家参加了第二轮调查。最终选定了 12 项 PI。在最初的 10 个 PI 中,3 个未经修改就被选中,7 个经过修改后被选中。此外,还有 2 个新建议的 PI 被选中。12 个 PI 中有 10 个具有良好的临床特性:结论:所选的 12 个 PI 涵盖了全科医生不适当和不必要使用抗生素的主要情况。这些PIs可通过日常收集的医疗保险报销数据轻松计算,可用于向处方者和利益相关者提供反馈,帮助改善初级医疗中的抗生素处方。
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Selection of proxy indicators estimating the appropriateness of antibiotic prescriptions in general practice: a national consensus procedure in France.

Background: GPs are responsible for more than 70% of outpatient antibiotic prescriptions in France. Metrics are important antibiotic stewardship tools that can be used to set targets for improvement and to give feedback to professionals and stakeholders.

Objectives: The primary objective of the present study was to select a set of proxy indicators (PIs) based on 10 previously developed PIs, to estimate the appropriateness of antibiotic prescriptions by GPs. The secondary objective was to evaluate the clinimetric properties of the selected PIs.

Methods: A RAND-modified Delphi consensus procedure was conducted with a multidisciplinary panel of stakeholders. This procedure consisted of two successive online surveys with a consensus meeting in between. Clinimetric properties (measurability, applicability and potential room for improvement) were evaluated for the PIs selected through the consensus procedure, using 2022 Regional Health Insurance data.

Results: Seventeen experts participated in the first-round survey and 14 in the second-round. A final set of 12 PIs was selected. Among the 10 initial PIs, 3 were selected without modification and 7 were modified and selected. Moreover, two newly suggested PIs were selected. Ten of the 12 PIs presented good clinimetric properties.

Conclusions: The 12 selected PIs cover the main situations responsible for inappropriate and unnecessary use of antibiotics in general practice. These PIs, easily calculable using routinely collected health insurance reimbursement data, might be used to give feedback to prescribers and stakeholders and help improve antibiotic prescriptions in primary care.

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CiteScore
5.30
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审稿时长
16 weeks
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