Effect of an Outpatient Antimicrobial Stewardship Intervention on Broad-Spectrum Antibiotic Prescribing by Primary Care Pediatricians A Randomized Trial
Effect of an Outpatient Antimicrobial Stewardship Intervention on Broad-Spectrum Antibiotic Prescribing by Primary Care Pediatricians A Randomized Trial
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DOI：
10.1001/jama.2013.6287
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发表时间：
2013-06-12
影响因子：
120.7
通讯作者：
Zaoutis, Theoklis E.
中科院分区：
文献类型：
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作者：
Gerber, Jeffrey S.;Prasad, Priya A.;Zaoutis, Theoklis E.
重要性抗菌药物管理计划对住院患者有效，通常是通过处方审计和反馈。目的评价抗菌药物管理干预对儿科门诊患者抗菌药物处方的影响。设计门诊抗菌药物管理随机对照试验，使用相同的电子病历进行干预和对照。在排除了患有慢性疾病、抗生素过敏和先前使用抗生素的儿童后，我们估计了从干预前20个月到干预后12个月(2008年10月至2011年6月)针对年龄、性别、种族和保险进行标准化的靶向ARTIS的处方率。设置和参与者宾夕法尼亚州和新泽西州的25个儿科初级保健实践网络；干预1年后，对细菌性和病毒性关节炎的处方进行1年的个性化、季度审核和反馈。干预后1年，细菌性关节炎的广谱(非指南)抗生素处方和病毒性关节炎的抗生素处方的主要结果和测量率。结果干预后1年，细菌性关节炎的广谱抗生素处方从26.8%下降到14.3%(绝对差异，12.5%)，而干预实践的广谱抗生素处方从28.4%下降到22.6%(绝对差异，P<0.05)。5.8%)对照组(差异差[DOD]，6.7%；P=.01表示轨迹的差异)。在干预措施中，肺炎儿童的非指南处方从15.7%下降到4.2%，而对照组从17.1%下降到16.3%(DOD，10.7%；P
Importance Antimicrobial stewardship programs have been effective for inpatients, often through prescribing audit and feedback. However, most antimicrobial use occurs in outpatients with acute respiratory tract infections (ARTIs).Objective To evaluate the effect of an antimicrobial stewardship intervention on antibiotic prescribing for pediatric outpatients.Design Cluster randomized trial of outpatient antimicrobial stewardship comparing prescribing between intervention and control practices using a common electronic health record. After excluding children with chronic medical conditions, antibiotic allergies, and prior antibiotic use, we estimated prescribing rates for targeted ARTIs standardized for age, sex, race, and insurance from 20 months before the intervention to 12 months afterward (October 2008-June 2011).Setting and Participants A network of 25 pediatric primary care practices in Pennsylvania and New Jersey; 18 practices (162 clinicians) participated.Interventions One 1-hour on-site clinician education session (June 2010) followed by 1 year of personalized, quarterly audit and feedback of prescribing for bacterial and viral ARTIs or usual practice.Main Outcomes and Measures Rates of broad-spectrum (off-guideline) antibiotic prescribing for bacterial ARTIs and antibiotics for viral ARTIs for 1 year after the intervention.Results Broad-spectrum antibiotic prescribing decreased from 26.8% to 14.3% (absolute difference, 12.5%) among intervention practices vs from 28.4% to 22.6% (absolute difference, 5.8%) in controls (difference of differences [DOD], 6.7%; P=.01 for differences in trajectories). Off-guideline prescribing for children with pneumonia decreased from 15.7% to 4.2% among intervention practices compared with 17.1% to 16.3% in controls (DOD, 10.7%; P