99. Presence of Chronic Diseases and Compliance with Québec Provincial Guidelines for Outpatient Antibiotic Prescription, Québec, Canada, 2010-2017
Bibliographic record
Abstract
Abstract Background In Québec primary care, antimicrobial use is higher in patients with chronic diseases, but it is unclear whether this utilization may be reduced. We aimed to measure the proportion of compliant antimicrobial prescriptions according to the provincial guidelines for the treatment of common respiratory and urinary infections and measure variations in this proportion with certain chronic diseases. Methods Antimicrobial dispensing covered by the public drug insurance plan between April 2010 and March 2017, delivered within 2 days of an outpatient consultation for an infection was included. Infections targeted by provincial guidelines were studied: otitis media, pharyngitis, pneumonia, sinusitis, bronchitis and chronic obstructive pulmonary disease exacerbations, cystitis, and acute pyelonephritis. The proportion of prescriptions compliant with guidelines (right antimicrobial for children, and right antimicrobial and dosage for adults) was computed by age group (children or adults) and per category of chronic disease (respiratory, cardiovascular, diabetes, mental disorder, none of previous). For each infection and age group, multivariate robust Poisson regression was used to measure the impact of categories of chronic diseases on proportions of prescriptions compliant with guidelines. Results Between 14 677 and 312 786 prescriptions were included, for each infection. Compliance to guidelines was above 87% in children and was significantly lower (≤ 3% bellow) in children with asthma. In adults, the choice of agent was compliant for at least 73% of prescriptions, except for cases of pharyngitis (between 53% and 61%). Accounting for dosage led to lower proportions of compliance, which varied between 19% (cystitis with diabetes) and 77% (pyelonephritis with none of the studied chronic disease categories). Compliant prescriptions were 2,4% to 20,4% less frequent in the presence of chronic diseases (statistically significant). Conclusion Non-compliant prescriptions could still be appropriate, but their high frequency suggests there is room for improvement. Dosage seems particularly problematic. Additional support could be offered to clinicians for the prescription of antimicrobials to patients with chronic diseases. Disclosures All Authors: No reported disclosures
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".