Int J Health Geogr - Geographical epidemiology of antibacterials in the preschool age.


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CKGROUND: 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.

Resumo Limpo

ckground themat map allow rapid immedi read geograph differ distribut data refer specif territori aim studi show first time applic statist cartograph tool analysi drug util pediatr popul italian region assess intraregion differ antibiot prescriptionsmethod assess type geograph distribut prescript analys base standard preval rate zscore calcul local health unit health district municip level pearson coeffici correl use evalu correl hospit moran index use evalu exist spatial autocorrel use getisord g statist cluster area high low level preval identifi map probabl receiv least one prescript antibacteri year children includ studi evalu logist regress modelresult use map possibl see prescript correl health status popul tendenc pediatrician prescrib drug also confirm logist regress model construct estim probabl receiv least one prescript antibacteri consid independ variabl age sex preval hospit district resid prescript attitud pediatrician sex pediatrician pediatrician age group durat pediatrician contract local health unit lhuconclus prioriti action ration use antibacteri preschool age concentr activ particip pediatrician perman educ activ moreov compet author increas effort limit unnecessari prescript increas appropri prescrib

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