Едукацијата и пропишувањето на антибиотици за акутни респираторни инфекции во примарната здравствена заштита

Abstract

Acute respiratory infections (ARIs) are one of the most common reasons for visiting the Primary Health Care Doctors (PHC). An increased and unnecessary prescribed antibiotics (AB) for ARIs is a global health problem. 80% of ABs is prescribed in PHC for ARI. Doctors in PHC play a key role in the increased prescribing of AB. Implementation of guidelines based on evidence-based medicine (MBD) in practice may results in reduction of prescribing AB for ARI. Aim: To determine the impact of the targeted (centered) education of PHC doctors on the rate of AB prescribing for ARIs Objectives: To determine the impact of the targeted education of PHC doctors in establishing a proper diagnosis according to our guidelines, to choose an appropriate antibiotic, an according to national guidelines. Material and Methods: The study is part of the National Project for Prescribing AB for ARIs by the International Primary Care Respiratory Group (IPCRG). The survey was done as an analytical case control study implemented in November 2016 at the PHC level in seven regions of the Republic of Macedonia. In the research group took participation 95 doctors divided in two groups (investigated and control group). Before starting the survey the investigated group of 49 doctors received previous one day centered education for ARIs according to the national guidelines for ARIs. The control group included 46 PHC doctors but without centered education. A research questionnaire was filled in for all patients with ARIs who had been visited their clinics. The results obtained are analyzed using standardized analytical methods. Results: An analysis of a sample of 8259 patients found that the prescribing AB rate in the investigated group was 60.5%, in the control group (59.7%) and there was no significant differences between the groups (p = 0.4644). The most prescribed AB in the both group was Amoxicillin + clavulonic acid. We found very low percentage of prescribed Penicillin V (5,1%) in the both groups, significantly greater prescribing of Amoxicillin in the investigated group and increased use of third-generation cephalosporins in the control group. A significantly higher number of AB was prescribed due to insecurity in establishing of diagnosis in the control group. The analysis of the cross-ratio showed that the referral to a specialist was 17.4% significantly less in the doctors of the examined group. The control group significantly used the strategy of delayed prescribing of AB. AB prescribing at the patient / parent pressure is significantly higher in the control group. The most AB were prescribed for ICD10 diagnoses of the Group 1 (54.8%) and Group5 (20,1%)in all sample with significantly higher prescribing of AB in the examined group, and significantly higher in the Group 2 and Group 4 of ICD10 diagnosis in the control group. Conclusion: We concluded that the short-term targeted education of doctors from PHC did not have a significant influence on the rate of AB prescribing for ARI. Significant differences have been noted between the groups. The most commonly used AB is amoxicillin + clavulic acid that does not correspond to the recommendations of the national guidelines.