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Geographical epidemiology of antibacterials in the preschool age.

Cartabia M, Campi R, Clavenna A, Bortolotti A, Fortino I, Merlino L, Bonati M - Int J Health Geogr (2012)

Bottom Line: This was also confirmed by the logistic regression model constructed to estimate the probability of receiving at least one prescription of antibacterials considering, as independent variables: age, sex, prevalence of hospitalizations in the district of residence, prescriptive attitude of the pediatrician, sex of the pediatrician, pediatrician's age group, and duration of the pediatrician's contract with the local health unit (LHU).The priority actions to rationalize the use of antibacterials in the preschool age should concentrate on the active participation of the pediatricians in permanent education activities.Moreover, the competent authorities should increasing their efforts to limit unnecessary prescriptions and increase appropriateness of prescribing.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Public Health, Mario Negri Pharmacological Research Institute, Milan, Italy. massimo.cartabia@marionegri.it

ABSTRACT

Background: Thematic maps allow a more rapid and immediate reading of the geographical differences in the distribution of data referred to a specific territory. The aim of this study was to show, for the first time, the application of some statistical and cartographic tools in the analysis of drug utilization in the pediatric population of an Italian region, and to assess the intra-regional difference in the antibiotic prescriptions.

Methods: To assess the type of geographic distribution of the prescriptions, the analyses were based on the standardized prevalence rate (z-score) calculated at the local health unit, health district, and municipality levels. Pearson's coefficient of correlation was used to evaluate the correlation with hospitalization and the Moran's I index was used to evaluate the existence of spatial autocorrelation. With the use of Getis-Ord's G statistic, clusters of areas with high and low levels of prevalence were identified and mapped. The probability of receiving at least one prescription of antibacterials during the year for all the children included in the study was evaluated with a logistic regression model.

Results: With the use of the maps it was possible to see that the prescriptions were not correlated with the health status of the population, but with the tendency of the pediatrician to prescribe drugs. This was also confirmed by the logistic regression model constructed to estimate the probability of receiving at least one prescription of antibacterials considering, as independent variables: age, sex, prevalence of hospitalizations in the district of residence, prescriptive attitude of the pediatrician, sex of the pediatrician, pediatrician's age group, and duration of the pediatrician's contract with the local health unit (LHU).

Conclusions: The priority actions to rationalize the use of antibacterials in the preschool age should concentrate on the active participation of the pediatricians in permanent education activities. Moreover, the competent authorities should increasing their efforts to limit unnecessary prescriptions and increase appropriateness of prescribing.

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Related in: MedlinePlus

Territorial clusters of the prevalence rate of prescriptions at the health district and municipality level.
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Figure 1: Territorial clusters of the prevalence rate of prescriptions at the health district and municipality level.

Mentions: The prevalence rate of antibacterial prescriptions in the 97 health districts of the Lombardy Region included in the study varies from a minimum of 36.7% to a maximum of 66.6%, with a mean of 56.0% and a standard deviation of 5.4. The Moran’s I Index is equal to 0.27, corresponding to a z-score of 4.70 (p-value <0.0001), meaning that there is a significant spatial autocorrelation, and that it may be possible to find spatial clusters. The value of Moran’s I Index is not very high, but the z test confirms that it is significant and significant spatial clusters, in fact, have been found. Map 1A in Figure 1 shows two clusters of health districts with low values of prescription rates: one in the north of the region and the other that corresponds to the City of Milano. There is also a large cluster of health districts with high values of prescription rates represented by the Vallecamonica-Sebino LHU and almost the entire LHU of Brescia. The data obtained for this study can be inspected in more detail and the distribution of the prevalence rate of prescriptions at the municipal level can be evaluated to understand if the spatial autocorrelation remains or disappears.


Geographical epidemiology of antibacterials in the preschool age.

Cartabia M, Campi R, Clavenna A, Bortolotti A, Fortino I, Merlino L, Bonati M - Int J Health Geogr (2012)

Territorial clusters of the prevalence rate of prescriptions at the health district and municipality level.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3539941&req=5

Figure 1: Territorial clusters of the prevalence rate of prescriptions at the health district and municipality level.
Mentions: The prevalence rate of antibacterial prescriptions in the 97 health districts of the Lombardy Region included in the study varies from a minimum of 36.7% to a maximum of 66.6%, with a mean of 56.0% and a standard deviation of 5.4. The Moran’s I Index is equal to 0.27, corresponding to a z-score of 4.70 (p-value <0.0001), meaning that there is a significant spatial autocorrelation, and that it may be possible to find spatial clusters. The value of Moran’s I Index is not very high, but the z test confirms that it is significant and significant spatial clusters, in fact, have been found. Map 1A in Figure 1 shows two clusters of health districts with low values of prescription rates: one in the north of the region and the other that corresponds to the City of Milano. There is also a large cluster of health districts with high values of prescription rates represented by the Vallecamonica-Sebino LHU and almost the entire LHU of Brescia. The data obtained for this study can be inspected in more detail and the distribution of the prevalence rate of prescriptions at the municipal level can be evaluated to understand if the spatial autocorrelation remains or disappears.

Bottom Line: This was also confirmed by the logistic regression model constructed to estimate the probability of receiving at least one prescription of antibacterials considering, as independent variables: age, sex, prevalence of hospitalizations in the district of residence, prescriptive attitude of the pediatrician, sex of the pediatrician, pediatrician's age group, and duration of the pediatrician's contract with the local health unit (LHU).The priority actions to rationalize the use of antibacterials in the preschool age should concentrate on the active participation of the pediatricians in permanent education activities.Moreover, the competent authorities should increasing their efforts to limit unnecessary prescriptions and increase appropriateness of prescribing.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Public Health, Mario Negri Pharmacological Research Institute, Milan, Italy. massimo.cartabia@marionegri.it

ABSTRACT

Background: Thematic maps allow a more rapid and immediate reading of the geographical differences in the distribution of data referred to a specific territory. The aim of this study was to show, for the first time, the application of some statistical and cartographic tools in the analysis of drug utilization in the pediatric population of an Italian region, and to assess the intra-regional difference in the antibiotic prescriptions.

Methods: To assess the type of geographic distribution of the prescriptions, the analyses were based on the standardized prevalence rate (z-score) calculated at the local health unit, health district, and municipality levels. Pearson's coefficient of correlation was used to evaluate the correlation with hospitalization and the Moran's I index was used to evaluate the existence of spatial autocorrelation. With the use of Getis-Ord's G statistic, clusters of areas with high and low levels of prevalence were identified and mapped. The probability of receiving at least one prescription of antibacterials during the year for all the children included in the study was evaluated with a logistic regression model.

Results: With the use of the maps it was possible to see that the prescriptions were not correlated with the health status of the population, but with the tendency of the pediatrician to prescribe drugs. This was also confirmed by the logistic regression model constructed to estimate the probability of receiving at least one prescription of antibacterials considering, as independent variables: age, sex, prevalence of hospitalizations in the district of residence, prescriptive attitude of the pediatrician, sex of the pediatrician, pediatrician's age group, and duration of the pediatrician's contract with the local health unit (LHU).

Conclusions: The priority actions to rationalize the use of antibacterials in the preschool age should concentrate on the active participation of the pediatricians in permanent education activities. Moreover, the competent authorities should increasing their efforts to limit unnecessary prescriptions and increase appropriateness of prescribing.

Show MeSH
Related in: MedlinePlus