Effect of an educational intervention on optimizing antibiotic prescribing in long-term care facilities
Effect of an educational intervention on optimizing antibiotic prescribing in long-term care facilities
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DOI：
10.1111/j.1532-5415.2007.01250.x
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发表时间：
2007-08-01
影响因子：
6.3
通讯作者：
Cotton-Montpetit, Marie
中科院分区：
文献类型：
--
作者：
Monette, Johanne;Miller, Mark A.;Cotton-Montpetit, Marie
目的：为了评估教育干预的效果，旨在优化抗生素处方在长期护理（LTC）facilities.Design：群集随机对照试验。设置：8个公共LTC设施在蒙特利尔地区。参与者：36名医生。Intervention：教育干预包括邮寄抗生素指南给医生沿着他们的抗生素处方配置文件，涵盖前3个月。目标感染为尿路、下呼吸道、皮肤和软组织以及不明原因的败血症。在处方配置文件中，将每种抗生素分类为粘附或不粘附指南。实验组的医生接受干预两次，相隔4个月，而在对照组的医生提供常规care.Measurements：抗生素处方的数据收集了4个3个月的时间：干预前，干预后I，干预后II，和后续行动。结果：研究结束时，实验组与对照组的不依从抗生素处方比例分别下降了20.5%和5.1%。基于GEE模型，在干预后II，在实验组的医生64%，不遵守处方的抗生素比那些在对照组（比值比= 0.36，95%置信区间= 0.18-0.73）。结论：教育干预相结合的抗生素指南和处方配置文件是有效的，在减少不遵守抗生素处方。可能需要定期重复干预以保持其有效性。
Objective: To assess the effect of an educational intervention aimed at optimizing antibiotic prescribing in longterm care (LTC) facilities.Design: Cluster randomized, controlled trial.Setting: Eight public LTC facilities in the Montreal area.Participants: Thirty-six physicians.Intervention: The educational intervention consisted of mailing an antibiotic guide to physicians along with their antibiotic prescribing profile covering the previous 3 months. Targeted infections were urinary tract, lower respiratory tract, skin and soft tissues, and septicemia of unknown origin. In the prescribing profile, each antibiotic was classified as adherent or nonadherent to the guide. Physicians in the experimental group received the intervention twice, 4 months apart, whereas physicians in the control group provided usual care.Measurements: Data on antibiotic prescriptions were collected over four 3-month periods: preintervention, post-intervention I, postintervention II, and follow-up. A generalized estimating equation (GEE) model was used to compare the proportion of nonadherent antibiotic prescriptions of the experimental and control groups.Results: By the end of the study, nonadherent antibiotic prescriptions decreased by 20.5% in the experimental group, compared with 5.1% in the control group. Based on the GEE model, during postintervention II, physicians in the experimental group were 64% less likely to prescribe nonadherent antibiotics than those in the control group (odds ratio = 0.36, 95% confidence interval = 0.18-0.73).Conclusion: An educational intervention combining an antibiotic guide and a prescribing profile was effective in decreasing nonadherent antibiotic prescriptions. Repetition of the intervention at regular intervals may be necessary to maintain its effectiveness.