門診醫師以抗生素治療上呼吸道感染症與急性支氣管炎的影響因素與介入策略

Factors Influencing Antibiotic Prescriptions for Patients with Airborne Infections and Intervention Strategies to Change Antibiotic Prescribing Behavior by Ambulatory Care Physicians

10.6288/TJPH2006-25-05-02

劉嘉年(Chia-Nine Liu)；楊志良(Chih-Liang Yaung)

抗生素處方 ； 門診 ； 上呼吸道感染症 ； 急性支氣管炎 ； 介入策略 ； Antibiotic prescribing ； Ambulatory care ； Upper respiratory tract infections ； Acute bronchitis ； Intervention strategies

台灣公共衛生雜誌

25卷5期（2006 / 10 / 01）

330 - 339

繁體中文

不當使用抗生素治療上呼吸道感染症，是導致病菌抗藥性的主因之一。瞭解醫師處方行為的影響因素與有效的介入策略，可以提供政策建議減少不當抗生素的使用。透過文獻探討，分析討門診醫師使用抗生素治療上呼吸道感染症與急性支氣管炎的影響因素與介入策略。結果發現醫師處方行為受到醫療與臨床因素、醫病互動、醫療組織因素、醫療保險與政策等因素影響。單一提供書面衞教或審核回饋的介入策略，對醫師的抗生素處方行為的影響有限，而針對醫師、病患與社區民眾的多面向介入較能有效改變醫師行為，延緩處方的介入策略則是有效又低成本的介入方式。未來宜針對高抗生素處方之醫師進行影響因素的分析，採用多面向的介入模式，進行醫師在職教育與病患衛教，審核醫師檔案並加以回饋，並選派藥劑師至高抗生素處方醫師的診所提供專業建議。

The excessive use of antibiotics in ambulatory patients with airborne infections in Taiwan is associated with increased rates of antibiotic-resistant bacteria. To understand the factors which influence the prescribing of antibiotics and develop intervention strategies to reduce the inappropriate use of antibiotics would be helpful in providing suggestions for policy making. We reviewed the literature and identified important factors underlying antibiotic prescribing behaviors by ambulatory care physicians for patients with URIs and acute bronchitis and the intervention strategies successfully employed to limit the over-prescription of antibiotics. The results revealed that imprudent prescribing of antibiotics in ambulatory care was influenced by clinical factors, physician-patient interactions, health care organization factors, type of health insurance coverage, and policy factors. A simple, single-intervention, in the form of printed educational materials, medication audits, or performance feedback, generally resulted in small changes in prescribing behaviors. Multi-faceted interventions involving physicians, patients, and community education programs consistently produced moderate changes in prescribing behaviors. Delayed prescribing was an effective intervention with a low associated cost to reduce antibiotic use for viral respiratory tract infections. Efforts to reduce the inappropriate prescribing of antibiotics should target the high-prescribing physicians and apply multi-faceted interventions involving a combination of healthcare providers with consumer education, medication audits, and performance feedback, supplemented by educational outreach from pharmaceutical representatives.

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