Interrupted time-series analysis to evaluate the impact of a behavioral change outpatient antibiotic stewardship intervention.
Interrupted time-series analysis to evaluate the impact of a behavioral change outpatient antibiotic stewardship intervention.
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DOI：
10.1017/ash.2021.203
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
May, Larissa
中科院分区：
文献类型：
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作者：
Morgan, Brittany L;Bettencourt, Haylee;May, Larissa
我们评估了行为强化质量改进干预在减少抗生素无反应急性呼吸道感染（阿里斯）抗生素处方数量方面的作用。次要目的是确定在立即实施干预措施后，不适当的抗生素处方（如果存在）是否持续减少。2017年1月至2020年2月进行的非随机、准实验研究。加州大学戴维斯分校健康门诊部。总共包括10个城镇的21个儿科，家庭和内科实践。在研究期间，由参与医生在入组的临床试验机构评价的患者，其诊断（原发性和继发性）来自国际疾病分类第十版代码，与抗生素无反应ARI诊断一致。一种行为增强的质量改进干预措施，以减少抗生素无反应ARI的不适当处方。分析中共纳入了21个地点的63，028例合格患者访视。抗生素无反应性ARI最常使用的抗生素是阿奇霉素（n = 3，551），其次是阿莫西林（n = 924）。总体而言，干预后抗生素无反应性ARI的抗生素处方立即减少了46%（P = .001）。我们发现，在实施干预措施后，每月的趋势没有显著变化（P = 0.87），这表明在整个干预后期间，这种减少是持续的。我们的研究结果表明，一个行为增强质量改进干预，以减少不适当的处方抗生素无反应的ARI在门诊护理遇到成功地减少潜在的不适当的处方假定抗生素无反应的ARI。
We evaluated the effect of a behaviorally enhanced quality improvement intervention in reducing the number of antibiotic prescriptions written for antibiotic nonresponsive acute respiratory infections (ARIs). A secondary objective was identifying whether a reduction in inappropriate antibiotic prescriptions, if present, persisted after the immediate implementation of the intervention. Nonrandomized, quasi-experimental study conducted from January 2017 through February 2020. University of California, Davis Health outpatient clinics. In total, 21 pediatric, family, and internal medicine practices in 10 cities and towns were included. Patients evaluated by a participating physician at an enrolled practice site during the study period with diagnoses (primary and secondary) from the International Classification of Diseases, Tenth Revision codes consistent with antibiotic nonresponsive ARI diagnoses. A behaviorally enhanced quality improvement intervention to reduce inappropriate prescribing for antibiotic nonresponsive ARI. In total, 63,028 eligible patient visits across 21 locations were included in the analysis. The most frequently prescribed antibiotic for antibiotic nonresponsive ARI was azithromycin (n = 3,551), followed by amoxicillin (n = 924). Overall, the intervention was associated with an immediate 46% reduction in antibiotic prescriptions for antibiotic nonresponsive ARI (P = .001) following the intervention. We detected no significant change in the month-to-month trend after the intervention was implemented (P = .87), indicating that the reduction was sustained throughout the postintervention period. Our findings demonstrate that a behaviorally enhanced quality improvement intervention to reduce inappropriate prescribing for antibiotic nonresponsive ARI in ambulatory care encounters was successful in reducing potentially inappropriate prescriptions for presumed antibiotic nonresponsive ARI.