Audit propisivanja antibiotika kao alat za unaprjeđenje kvalitete rada u obiteljskoj medicini

Ana Klir Klasić, Venija Cerovečki, Mladen Oršolić, Mario Ćurković

Uvod i cilj: Primarna zdravstvena zaštita ima ključnu ulogu u propisivanju antibiotika. Cilj audita bio je procijeniti obrasce i opravdanost propisivanja oralnih antibiotika u ordinaciji obiteljske medicine te njihovu usklađenost sa smjernicama i mogućnošću unaprjeđenja kvalitete rada. Ispitanici i metode: U audit je uključeno 259 pacijenata kojima je u jednogodišnjem razdoblju propisan oralni antibiotik bilo prema odluci specijalista obiteljske medicine (SOM) ili prema preporuci bolničkog liječnika specijalista. Opravdanost indikacije procjenjivana je prema važećim međunarodnim i nacionalnim smjernicama. Statistička analiza provedena je testom hi-kvadrat (χ² testom) i Fisherovim egzaktnim testom. Rezultati: Medijan dobi bio je 61 godina (interkvartilni raspon 44–73), 61% ispitanika bile su žene. Zabilježena je sezonska varijabilnost s vrhuncem u studenome (13,1%). Najčešće dijagnoze bile su genitourinarne (41,3%) i respiratorne (26,6%). Klinička dijagnoza postavljena je u 62,9%, a dijagnostička obrada u 69,5%. Terapiju je najčešće ordinirao SOM (71%). Najčešći antibiotici bili su amoksicilin s klavulanskom kiselinom (31,7%) i nitrofurantoin (13,5%), dok su penicilini bili najzastupljenija farmakološka skupina (47,1%). Indikacija je bila opravdana u 90% slučajeva, uz statistički značajnu razliku prema specijalizaciji liječnika (P < 0,001). Zaključak: Antibiotici se u primarnoj zdravstvenoj zaštiti najčešće propisuju za genitourinarne i respiratorne infekcije uz sezonsku varijabilnost. Prevladavajuća primjena antibiotika kategorije „Watch“ (antibiotici širokog spektra) upućuje na potrebu većeg udjela antibiotika kategorije „Access“ (antibiotici užeg spektra). Razlike u opravdanosti indikacija s obzirom na specijalizaciju liječnika koji ih ordiniraju naglašavaju važnost programa antimikrobnog upravljanja.

Introduction and aim: Primary health care plays a key role in antibiotic prescribing. The aim of the audit was to assess the patterns and justification of prescribing oral antibiotics in family medicine practice, as well as their compliance with guidelines and opportunities for quality improvement. Participants and methods: The audit included 259 participants who were prescribed an oral antibiotic over a one-year period, either by a family medicine specialist (FMS) or based on a recommendation from a hospital-based specialist. Appropriateness was assessed according to international and national guidelines. Statistical analysis was performed using the chisquare test (χ² test) and Fisher’s exact test. Results: The median age was 61 years (interquartile range 44–73), and 61 % of the subjects were female. Seasonal variability was observed, with a peak in November (13.1 %). The most common diagnoses were genitourinary (41.3 %) and respiratory (26.6 %). Clinical diagnosis was made in 62.9 %, while diagnostic testing was performed in 69.5 %. Most antibiotics were prescribed by FMS (71 %). The most frequently used antibiotics were amoxicillin-clavulanate (31.7 %) and nitrofurantoin (13.5 %), while penicillins represented the most commonly prescribed antibiotic class (47.1 %). Indications were appropriate in 90 %, with a statistically significant difference according to physician specialty (P < 0.001). Conclusion: In primary health care, antibiotics are most commonly prescribed for genitourinary and respiratory infections with seasonal variability. The predominant use of Watch category antibiotics (broad-spectrum antibiotics) indicates a need to increase the use of Access category antibiotics (narrower-spectrum antibiotics). Differences in prescribing appropriateness between physician specialties highlight the importance of antimicrobial stewardship programs.