Cluster-randomized trial to improve antibiotic use for adults with acute respiratory infections treated in emergency departments
Cluster-randomized trial to improve antibiotic use for adults with acute respiratory infections treated in emergency departments
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DOI：
10.1016/j.annemergmed.2007.03.022
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发表时间：
2007-09-01
影响因子：
6.2
通讯作者：
Gonzales, Ralph
中科院分区：
文献类型：
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作者：
Metlay, Joshua P.;Camargo, Carlos A.;Gonzales, Ralph
研究目的：我们评估医院急诊科 (ED) 旨在减少急性呼吸道感染抗生素过度使用的教育计划的有效性。方法：16 家医院参与了整群随机试验，在 8 个大都市地区各选择一家退伍军人管理局 (VA) 和非退伍军人管理局 (VA) 医院。干预站点收到绩效反馈、临床医生教育和患者教育材料，包括位于候诊室的交互式电脑亭。在基线第一年和干预第二年，对每个地点的医疗记录进行了审查。效果的主要衡量标准是因上呼吸道感染和急性支气管炎而接受抗生素治疗的就诊百分比。通过对患者进行后续电话访谈来评估次要结果，包括回访和就诊满意度。使用交替逻辑回归模型来调整基线治疗率、病例组合差异和提供者特征。结果：第一年，对照地点的上呼吸道感染/急性支气管炎就诊的抗生素处方水平调整后为 47%，干预地点为 52%。第一年和第二年之间，对照地点的抗生素处方增加了 0.5%（95% 置信区间 -3% 至 5%），而干预地点则减少了 10%（95% 置信区间） -18% 至 -2%）。控制点和干预点之间，上呼吸道感染/支气管炎患者回诊急诊的比例或整体就诊满意度没有显着差异。结论：多维教育干预可以减少急诊科上呼吸道感染和急性支气管炎患者治疗中抗生素的过度使用。然而，尽管采取了这种教育干预措施，抗生素的大量过度使用仍然存在。
Study objective: We evaluate the effectiveness of an educational program in hospital emergency departments (EDs) targeting reduction in antibiotic overuse for acute respiratory tract infections.Methods: Sixteen hospitals participated in the cluster randomized trial, selecting a Veterans Administration (VA) and non-VA hospital within each of 8 metropolitan regions. Intervention sites received performance feedback, clinician education, and patient educational materials, including an interactive computer kiosk located in the waiting room. Medical records were reviewed at each site during the baseline year 1 and intervention year 2. The primary measure of effect was the percentage of visits for upper respiratory tract infections and acute bronchitis that were treated with antibiotics. Secondary outcomes, including return visits and visit satisfaction, were assessed by follow-up telephone interviews of patients. Alternating logistic regression models were used to adjust for baseline treatment rates, case mix differences, and provider characteristics.Results: The adjusted antibiotic prescription level for upper respiratory tract infection/acute bronchitis visits was 47% for control sites and 52% for intervention sites in year 1. Antibiotic prescriptions at control sites increased by 0.5% between year 1 and year 2 (95% confidence interval -3% to 5%) and at intervention sites decreased by 10% (95% confidence interval -18% to -2%). There were no significant differences between control and intervention sites in the proportions of upper respiratory tract infection/bronchitis patients with return ED visits or in overall visit satisfaction.Conclusion: Multidimensional educational interventions can reduce antibiotic overuse in the treatment of patients with upper respiratory tract infections and acute bronchitis in ElDs. However, substantial antibiotic overuse persists despite this educational intervention.