Does locally relevant, real-time infection epidemiological data improve clinician management and antimicrobial prescribing in primary care? A systematic review
Identifieur interne : 000539 ( Main/Exploration ); précédent : 000538; suivant : 000540Does locally relevant, real-time infection epidemiological data improve clinician management and antimicrobial prescribing in primary care? A systematic review
Auteurs : Isabel Lane [Royaume-Uni] ; Ashley Bryce [Royaume-Uni] ; Suzanne M. Ingle [Royaume-Uni] ; Alastair D. Hay [Royaume-Uni]Source :
- Family Practice [ 0263-2136 ] ; 2018.
Descripteurs français
- KwdFr :
- MESH :
- tendances : Types de pratiques des médecins.
- traitement médicamenteux : Grippe humaine, Infections de l'appareil respiratoire.
- usage thérapeutique : Antibactériens, Antiviraux.
- Humains, Prescription inappropriée, Soins de santé primaires.
English descriptors
- KwdEn :
- MESH :
- chemical , therapeutic use : Anti-Bacterial Agents, Antiviral Agents.
- drug therapy : Influenza, Human, Respiratory Tract Infections.
- prevention & control : Inappropriate Prescribing.
- trends : Practice Patterns, Physicians'.
- Humans, Primary Health Care.
Abstract
Antimicrobial resistance is a significant threat to public health. Diagnostic uncertainty is a key driver of antimicrobial prescribing. We sought to determine whether locally relevant, real-time syndromic or microbiological infection epidemiology can improve prescribing by reducing diagnostic uncertainty.
Eligible studies investigated effects on primary care prescribing for common infections in Organisation For Economic Co-Operation And Development countries. We searched Medline, Embase, Cumulative index to nursing and allied health literature, Web of Science, grey literature sources, thesis databases and trial registries.
We identified 9548 reports, of which 17 were eligible, reporting 12 studies, of which 3 reported relevant outcomes. The first (observational) showed antibacterial prescribing for upper respiratory infections reduced from 26.4% to 8.6% (
There is promising evidence that epidemiological syndromic and microbiological data can reduce primary care antimicrobial prescribing. Future research should use randomized designs of behaviourally informed interventions, investigate costs and harms, and establish mechanisms of behaviour change.
CRD42016038871.
Url:
DOI: 10.1093/fampra/cmy008
PubMed: 29529261
PubMed Central: 6142716
Affiliations:
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Le document en format XML
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A systematic review</title><author><name sortKey="Lane, Isabel" sort="Lane, Isabel" uniqKey="Lane I" first="Isabel" last="Lane">Isabel Lane</name><affiliation wicri:level="1"><nlm:aff id="AF0001">National Institute for Health Research School for Primary Care Research, Centre for Academic Primary Care, University of Bristol, Bristol, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>National Institute for Health Research School for Primary Care Research, Centre for Academic Primary Care, University of Bristol, Bristol</wicri:regionArea><wicri:noRegion>Bristol</wicri:noRegion></affiliation></author><author><name sortKey="Bryce, Ashley" sort="Bryce, Ashley" uniqKey="Bryce A" first="Ashley" last="Bryce">Ashley Bryce</name><affiliation wicri:level="1"><nlm:aff id="AF0001">National Institute for Health Research School for Primary Care Research, Centre for Academic Primary Care, University of Bristol, Bristol, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>National Institute for Health Research School for Primary Care Research, Centre for Academic Primary Care, University of Bristol, Bristol</wicri:regionArea><wicri:noRegion>Bristol</wicri:noRegion></affiliation></author><author><name sortKey="Ingle, Suzanne M" sort="Ingle, Suzanne M" uniqKey="Ingle S" first="Suzanne M" last="Ingle">Suzanne M. Ingle</name><affiliation wicri:level="1"><nlm:aff id="AF0002">The National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>The National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol</wicri:regionArea><wicri:noRegion>Bristol</wicri:noRegion></affiliation></author><author><name sortKey="Hay, Alastair D" sort="Hay, Alastair D" uniqKey="Hay A" first="Alastair D" last="Hay">Alastair D. Hay</name><affiliation wicri:level="1"><nlm:aff id="AF0001">National Institute for Health Research School for Primary Care Research, Centre for Academic Primary Care, University of Bristol, Bristol, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>National Institute for Health Research School for Primary Care Research, Centre for Academic Primary Care, University of Bristol, Bristol</wicri:regionArea><wicri:noRegion>Bristol</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="AF0002">The National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>The National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol</wicri:regionArea><wicri:noRegion>Bristol</wicri:noRegion></affiliation></author></analytic><series><title level="j">Family Practice</title><idno type="ISSN">0263-2136</idno><idno type="eISSN">1460-2229</idno><imprint><date when="2018">2018</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Anti-Bacterial Agents (therapeutic use)</term><term>Antiviral Agents (therapeutic use)</term><term>Humans</term><term>Inappropriate Prescribing (prevention & control)</term><term>Influenza, Human (drug therapy)</term><term>Practice Patterns, Physicians' (trends)</term><term>Primary Health Care</term><term>Respiratory Tract Infections (drug therapy)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Antibactériens (usage thérapeutique)</term><term>Antiviraux (usage thérapeutique)</term><term>Grippe humaine (traitement médicamenteux)</term><term>Humains</term><term>Infections de l'appareil respiratoire (traitement médicamenteux)</term><term>Prescription inappropriée ()</term><term>Soins de santé primaires</term><term>Types de pratiques des médecins (tendances)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Anti-Bacterial Agents</term><term>Antiviral Agents</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Influenza, Human</term><term>Respiratory Tract Infections</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Inappropriate Prescribing</term></keywords><keywords scheme="MESH" qualifier="tendances" xml:lang="fr"><term>Types de pratiques des médecins</term></keywords><keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr"><term>Grippe humaine</term><term>Infections de l'appareil respiratoire</term></keywords><keywords scheme="MESH" qualifier="trends" xml:lang="en"><term>Practice Patterns, Physicians'</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Antibactériens</term><term>Antiviraux</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Humans</term><term>Primary Health Care</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Humains</term><term>Prescription inappropriée</term><term>Soins de santé primaires</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>Abstract</title><sec id="s1"><title>Purpose</title><p>Antimicrobial resistance is a significant threat to public health. Diagnostic uncertainty is a key driver of antimicrobial prescribing. We sought to determine whether locally relevant, real-time syndromic or microbiological infection epidemiology can improve prescribing by reducing diagnostic uncertainty.</p></sec><sec id="s2"><title>Methods</title><p>Eligible studies investigated effects on primary care prescribing for common infections in Organisation For Economic Co-Operation And Development countries. We searched Medline, Embase, Cumulative index to nursing and allied health literature, Web of Science, grey literature sources, thesis databases and trial registries.</p></sec><sec id="s3"><title>Results</title><p>We identified 9548 reports, of which 17 were eligible, reporting 12 studies, of which 3 reported relevant outcomes. The first (observational) showed antibacterial prescribing for upper respiratory infections reduced from 26.4% to 8.6% (<italic>P</italic> = 0.01). The second (observational) showed antibacterial prescribing reduced during influenza pandemic compared with seasonal influenza periods [odds ratio (OR) 0.72 (95% CI, 0.68 to 0.77), <italic>P</italic> < 0.001], while antiviral prescribing increased [OR 6.43 (95% CI, 5.02 to 8.25), <italic>P</italic> < 0.001]. The likelihood of prescribing also decreased as the number of infection cases a physician saw increased in the previous week [OR 0.57 (95% CI, 0.51 to 0.63), <italic>P</italic> < 0.001 for ≥12 versus ≤1 patient). The third (randomized-controlled trial) showed an absolute reduction in antibacterial prescribing of 5.1% during a period of moderate influenza activity (<italic>P</italic> < 0.05). We did not find measures of diagnostic certainty, harms or costs.</p></sec><sec id="s4"><title>Conclusion</title><p>There is promising evidence that epidemiological syndromic and microbiological data can reduce primary care antimicrobial prescribing. Future research should use randomized designs of behaviourally informed interventions, investigate costs and harms, and establish mechanisms of behaviour change.</p></sec><sec id="s5"><title>PROSPERO registration</title><p>CRD42016038871.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Costelloe, C" uniqKey="Costelloe C">C Costelloe</name></author><author><name sortKey="Metcalfe, C" uniqKey="Metcalfe C">C Metcalfe</name></author><author><name sortKey="Lovering, A" uniqKey="Lovering A">A Lovering</name></author><author><name sortKey="Mant, D" uniqKey="Mant D">D Mant</name></author><author><name sortKey="Hay, Ad" uniqKey="Hay A">AD Hay</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bryce, A" uniqKey="Bryce A">A Bryce</name></author><author><name sortKey="Hay, Ad" uniqKey="Hay A">AD Hay</name></author><author><name sortKey="Lane, If" 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Hay</name><name sortKey="Hay, Alastair D" sort="Hay, Alastair D" uniqKey="Hay A" first="Alastair D" last="Hay">Alastair D. Hay</name><name sortKey="Ingle, Suzanne M" sort="Ingle, Suzanne M" uniqKey="Ingle S" first="Suzanne M" last="Ingle">Suzanne M. Ingle</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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|area= PandemieGrippaleV1
|flux= Main
|étape= Exploration
|type= RBID
|clé= PMC:6142716
|texte= Does locally relevant, real-time infection epidemiological data improve clinician management and antimicrobial prescribing in primary care? A systematic review
}}
Pour générer des pages wiki
HfdIndexSelect -h $EXPLOR_AREA/Data/Main/Exploration/RBID.i -Sk "pubmed:29529261" \
| HfdSelect -Kh $EXPLOR_AREA/Data/Main/Exploration/biblio.hfd \
| NlmPubMed2Wicri -a PandemieGrippaleV1
| This area was generated with Dilib version V0.6.34. |  |