Implementation of a novel antimicrobial stewardship strategy for rural facilities utilising telehealth
Implementation of a novel antimicrobial stewardship strategy for rural facilities utilising telehealth
复制标题
DOI：
10.1016/j.ijantimicag.2021.106346
复制
发表时间：
2021-05-22
影响因子：
10.8
通讯作者：
Daveson, K.
中科院分区：
文献类型：
--
作者：
Avent, M. L.;Walker, D.;Daveson, K.
医疗保健的很大一部分是在小医院进行的，其中许多位于农村和地区。这些地区的设施通常没有足够的资源来实施现场抗菌管理计划，并且有关其实施和有效性的数据有限。我们提出了一种创新模式，利用集中服务（昆士兰州全州抗菌药物管理计划）为农村医院和卫生服务提供专业远程医疗抗菌药物管理服务。实施后2年的随访结果显示，对指南的依从性有所改善[33.7%（95% CI 27.0-40.4%）vs. 54.1%（95% CI 48.7-59.5%）]和抗菌药物处方的适当性[49.0%（95% CI 42.2-55.9%）vs. 67.5%（95% CI 62.7-72.4%）（P < 0.001）。在对医院进行调整后，这一结果得以维持，多年来，指南依从性[调整后比值比（aOR）= 2.44，95% CI 1.70-3.51]和处方适当性（aOR = 2.48，95% CI 1.70-3.61）依次改善。2016年（52.82，95% CI 44.09-61.54）和2018年（39.74，95% CI 32.76-46.73）之间的平均抗生素总使用量（DDDs/100 0患者-天）有所下降，但未达到统计学显著性。此外，平均住院时间（天）从2016年（3.74，95% CI 3.08-4.41）减少至2018年（2.55，95% CI 1.98-3.12），但无统计学显著性。基于远程保健的新型抗菌药物管理模式可有效改善农村地区的处方。类似于我们的方案应考虑为农村设施。皇冠版权（c）2021由爱思唯尔有限公司发布。这是一个开放获取的文章下CC BY-NC-ND许可证（http://creativecommons.org/licenses/by-nc-nd/4.0/）
A significant portion of healthcare takes place in small hospitals, and many are located in rural and regional areas. Facilities in these regions frequently do not have adequate resources to implement an onsite antimicrobial stewardship programme and there are limited data relating to their implementation and effectiveness. We present an innovative model of providing a specialist telehealth antimicrobial stewardship service utilising a centralised service (Queensland Statewide Antimicrobial Stewardship Program) to a rural Hospital and Health Service. Results of a 2-year post-implementation follow-up showed an improvement in adherence to guidelines [33.7% (95% CI 27.0-40.4%) vs. 54.1% (95% CI 48.7-59.5%)] and appropriateness of antimicrobial prescribing [49.0% (95% CI 42.2-55.9%) vs. 67.5% (95% CI 62.7-72.4%) (P < 0.001). This finding was sustained after adjustment for hospitals, with improvement occurring sequentially across the years for adherence to guidelines [adjusted odds ratio (aOR) = 2.44, 95% CI 1.70-3.51] and appropriateness of prescribing (aOR = 2.48, 95% CI 1.70-3.61). There was a decrease in mean total antibiotic use (DDDs/100 0 patient-days) between the years 2016 (52.82, 95% CI 44.09-61.54) and 2018 (39.74, 95% CI 32.76-46.73), however this did not reach statistical significance. Additionally, there was a decrease in mean hospital length of stay (days) from 2016 (3.74, 95% CI 3.08-4.41) to 2018 (2.55, 95% CI 1.98-3.12), although this was not statistically significant. New telehealth-based models of antimicrobial stewardship can be effective in improving prescribing in rural areas. Programmes similar to ours should be considered for rural facilities.Crown Copyright (c) 2021 Published by Elsevier Ltd.This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )