Effect of unifaceted and multifaceted interventions on antibiotic prescription control for respiratory diseases: A systematic review of randomized controlled trials.
Effect of unifaceted and multifaceted interventions on antibiotic prescription control for respiratory diseases: A systematic review of randomized controlled trials.
复制标题
DOI：
10.1097/md.0000000000030865
复制
发表时间：
2022-10-14
期刊：
影响因子：
1.6
通讯作者：
中科院分区：
文献类型：
--
作者：
全球卫生系统不恰当地使用抗生素，特别是在治疗呼吸道疾病时。我们的目的是检验对不合理抗生素处方实施单方面和多方面干预的有效性。检索Pubmed、Embase、Science Direct、Cochrane Central Register of Controlled Trials、中国国家知识基础设施、万方数据库中发表的相关文献。数据由 2 位评价者根据预先设计的纳入和排除标准独立过滤和提取。 Cochrane 协作偏倚风险工具用于评估纳入的随机对照试验研究的质量。总共获得了 1390 项研究，其中 23 项研究的结果变量是抗生素处方率，处方数量和干预细节纳入系统评价。其中22项研究涉及对医生的教育干预，包括：使用电子邮件、网页和网络研讨会的在线培训，通过电子邮件、邮寄或电话提醒的信息传播措施的抗生素指南、医生沟通技巧培训、短期互动教育研讨会和短期现场培训课程。十七项针对医护人员干预措施的研究还包括：定期或不定期评估/审核抗生素处方、专家和同行在会议或网上提出的处方建议、向患者、医院管理人员和卫生当局公开报告医生的抗生素使用情况、通过电子邮件或海报监测/反馈一般做法的处方行为以及涉及患者及其家人的研究（n = 8）。 21 项随机对照试验被评为具有低偏倚风险，而 2 项随机对照试验被评为具有高偏倚风险。六项研究得出阴性结果。教育、处方审核、专家处方建议、公开报告、处方反馈以及患者或家属多方位干预相结合，可以有效降低医疗机构抗生素处方率。而且，在教育干预的基础上加入多方面的干预措施可以控制抗生素处方率，可能是一种更合理的方法。本系统评价已在 PROSPERO 注册，注册号：CRD42020192560。
The global health system is improperly using antibiotics, particularly in the treatment of respiratory diseases. We aimed to examine the effectiveness of implementing a unifaceted and multifaceted intervention for unreasonable antibiotic prescriptions. Relevant literature published in the databases of Pubmed, Embase, Science Direct, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure and Wanfang was searched. Data were independently filtered and extracted by 2 reviewers based on a pre-designed inclusion and exclusion criteria. The Cochrane collaborative bias risk tool was used to evaluate the quality of the included randomized controlled trials studies. A total of 1390 studies were obtained of which 23 studies the outcome variables were antibiotic prescription rates with the number of prescriptions and intervention details were included in the systematic review. Twenty-two of the studies involved educational interventions for doctors, including: online training using email, web pages and webinar, antibiotic guidelines for information dissemination measures by email, postal or telephone reminder, training doctors in communication skills, short-term interactive educational seminars, and short-term field training sessions. Seventeen studies of interventions for health care workers also included: regular or irregular assessment/audit of antibiotic prescriptions, prescription recommendations from experts and peers delivered at a meeting or online, publicly reporting on doctors’ antibiotic usage to patients, hospital administrators, and health authorities, monitoring/feedback prescribing behavior to general practices by email or poster, and studies involving patients and their families (n = 8). Twenty-one randomized controlled trials were rated as having a low risk of bias while 2 randomized controlled trials were rated as having a high risk of bias. Six studies contained negative results. The combination of education, prescription audit, prescription recommendations from experts, public reporting, prescription feedback and patient or family member multifaceted interventions can effectively reduce antibiotic prescription rates in health care institutions. Moreover, adding multifaceted interventions to educational interventions can control antibiotic prescription rates and may be a more reasonable method. This systematic review was registered in PROSPERO, registration number: CRD42020192560.