Impact of a Multifaceted Pharmacist-Led Intervention on Antimicrobial Stewardship in a Gastroenterology Ward: A Segmented Regression Analysis
Impact of a Multifaceted Pharmacist-Led Intervention on Antimicrobial Stewardship in a Gastroenterology Ward: A Segmented Regression Analysis
复制标题
药剂师主导的多方面干预对胃肠病房抗菌药物管理的影响：分段回归分析
DOI：
10.3389/fphar.2020.00442
复制
发表时间：
2020-04-15
影响因子：
5.6
通讯作者：
Zhang Xinping
中科院分区：
文献类型：
--
作者：
Du Yaling;Li Jing;Zhang Xinping
背景胃肠道疾病抗菌药物的不合理使用值得关注，但相应的抗菌药物管理计划(ASP)通常不是管理者的优先事项。我们进行了这项研究，以评估胃肠病病房(GW)多层面药剂师主导(MPL)干预的有效性，为非优先科室应用ASP的有效性提供证据。方法采用前瞻性、前瞻性的研究方法，对中国进行研究。为期一年半的MPL干预包括与医生每天查房，定期审查医嘱，每月指标反馈，频繁的医生培训，以及必要的患者教育。从医院信息系统中提取了2016年1月至2018年12月36个月期间所有接受抗生素治疗的住院成年人的数据。对中断的时间序列进行分段回归分析，以评估MPL干预(始于2017年7月)对抗生素使用和住院时间的影响，以每月为分析单位计算。结果共纳入1763例接受抗生素治疗的患者。分段回归模型显示抗生素使用强度较基线有下降趋势(系数=−0.88，p=0.0 1)，包括接受联合抗生素治疗的患者比例(系数=−9.91，p=0.0 3)和平均住院时间(系数=−1.79，p=0.00)的变化水平显著下降。MPL干预导致接受抗生素治疗的患者比例暂时增加(系数=4.95，p=0.038)，但这是长期下降趋势的一部分(系数=−0.45，p=0.05)。结论与干预前相比，MPL干预导致干预后接受抗生素治疗的患者数量、抗生素消耗量和平均住院时间显著下降。卫生政策制定者应在那些未纳入优先管理的科室的ASP中积极实施临床药剂师的MPL干预。
Background Irrational use of antimicrobial agents for gastrointestinal diseases deserves attention, but corresponding antimicrobial stewardship programs (ASPs) are generally not a priority for managers. We conducted this study to evaluate the effectiveness of multifaceted pharmacist-led (MPL) interventions in the gastroenterology ward (GW) to provide evidence for the efficacy of ASPs in a non-priority department. Methods This was an interventional, retrospective study implemented in China. The MPL intervention lasting 1.5 years involved daily ward rounds with physicians, regular review of medical orders, monthly indicator feedback, frequent physician training, and necessary patient education. Data on all hospitalized adults receiving antibiotics was extracted from the hospital information system over a 36-month period from January 2016 to December 2018. Segmented regression analysis of interrupted time series was performed to evaluate the effect of the MPL interventions (started in July 2017) on antibiotic use and length of hospital stay, which was calculated monthly as analytical units. Results A total of 1763 patients receiving antibiotics were enrolled. Segmented regression models showed descending trends from the baseline in the intensity of antibiotic consumption (coefficient = −0.88, p = 0.01), including a significant decline in the level of change of the proportion of patients receiving combined antibiotics (coefficient = −9.91, p = 0.03) and average length of hospital stay (coefficient = −1.79, p = 0.00), after MPL interventions. The MPL interventions led to a temporary increase in the proportion of patients receiving antibiotics (coefficient = 4.95, p = 0.038), but this was part of a declining secular trend (coefficient = −0.45, p = 0.05). Conclusion The MPL interventions led a statistically significant decline in the number of patients receiving antibiotics, the antibiotic consumption, and the average hospital stay post-intervention compared to the pre-intervention phase of the study. Health policymakers should actively practice MPL interventions by clinical pharmacists in ASPs in those departments that are not included in priority management.