Effects of a feedback intervention on antibiotic prescription control in primary care institutions based on a Health Information System: a cluster randomized cross-over controlled trial
Effects of a feedback intervention on antibiotic prescription control in primary care institutions based on a Health Information System: a cluster randomized cross-over controlled trial
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DOI：
10.1016/j.jgar.2023.02.006
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发表时间：
2023-03-23
影响因子：
4.6
通讯作者：
Chang，Yue
中科院分区：
文献类型：
--
作者：
Yang，Junli;Cui，Zhezhe;Chang，Yue
目的抗生素的过度使用和滥用是中国农村基层医疗机构抗生素耐药性发展的主要因素。在这项研究中，评估了基于健康信息系统的、自动的、保密的抗生素反馈干预的有效性。方法在初级保健机构中进行了一项随机、交叉、整群对照试验。所有机构被随机分为两组，并进行三个月的干预，然后进行三个月的不干预，反之亦然。干预措施包括三项反馈措施：在处方医生的电脑屏幕上实时弹出抗生素处方不当警告信息、10天抗生素处方摘要以及分发教育手册。主要结局指标是 10 天抗生素不当处方率。结果 基线时，两组抗生素不当处方率（69.1% vs. 72.0%）无显着差异（P= 0.072）。三个月后（交叉点），与 B 组（4.4%，P< 0.001）相比，A 组（12.3%，P<0.001）不适当抗生素处方率下降速度明显更快。终点时，B组抗生素处方不当率下降（15.1%，P<0.001），而A组抗生素处方不当率上升（7.2%，P<0.001）。医生特征对抗生素或不当抗生素处方率没有显着影响。结论基于健康信息系统的实时弹出警告、10天处方汇总以及分发教育手册，可以有效降低抗生素和不当抗生素处方率。
ObjectivesOveruse and misuse of antibiotics are major factors in the development of antibiotic resistance in primary care institutions of rural China. In this study, the effectiveness of a Health Information System-based, automatic, and confidential antibiotic feedback intervention was evaluated.MethodsA randomized, cross-over, cluster-controlled trial was conducted in primary care institutions. All institutions were randomly divided into two groups and given either a three-month intervention followed by a three-month period without any intervention or vice versa. The intervention consisted of three feedback measures: a real-time pop-up warning message of inappropriate antibiotic prescriptions on the prescribing physician's computer screen, a 10-day antibiotic prescription summary, and distribution of educational manuals. The primary outcome was the 10-day inappropriate antibiotic prescription rate.ResultsThere were no significant differences in inappropriate antibiotic prescription rates (69.1% vs. 72.0%) between two groups at baseline (P= 0.072). After three months (cross-over point), inappropriate antibiotic prescription rates decreased significantly faster in group A (12.3%,P< 0.001) compared to group B (4.4%,P< 0.001). At the end point, the inappropriate antibiotic prescription rates decreased in group B (15.1%,P< 0.001) while the rates increased in group A (7.2%,P< 0.001). The characteristics of physicians did not significantly affect the rate of antibiotic or inappropriate antibiotic prescription rates.ConclusionA Health Information System-based, real-time pop-up warnings, a 10-day prescription summary, and the distribution of educational manuals, can effectively reduce the rates of antibiotic and inappropriate antibiotic prescriptions.