Optimizing Antibiotic Use in Long-Term Care

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DESCRIPTION: The primary aim of this study is to determine if an evidence-based clinical algorithm for managing urinary tract infections (UTIs) in older adults in residential long-term care facilities (LTCFs) can reduce the overall use of antibiotics in LTCFs. Three secondary objectives are: 1) to demonstrate the feasibility of implementing diagnostic and therapeutic evidence-based clinical algorithms in LTCFs; 2) to assess the safety of reducing the number of diagnostic tests and antibiotic use for UTIs in the target population; 3) to evaluate the process of adopting the algorithms in LTCFs. This study will use a combined quantitative and qualitative approach to evaluate the process and outcomes of implementing a clinical algorithm to optimize the use of antibiotics in residential LTCFs. For the quantitative component of the study, a randomized matched-pair design has been used where, within each of the 12 pairs of LTCFs, one was randomized to the intervention (clinical algorithm). The other half is providing "usual" management of presumptive urinary tract infections. Quantitative outcomes include 1) the proportion of antibiotic courses prescribed for urinary indications, 2) the total number of courses of antibiotics used, 3) rates of urine cultures ordered, 4) hospitalization rates for urinary tract infections, and 5) mortality rates. The qualitative component of the study will be a prospective case study evaluation of the clinical algorithms. This component of the study will exam the ease of implementation and health care provider satisfaction with the algorithms. This study was funded by AHRQ under the TRIP-II program in October 2000. The clinical trial is in progress and data collection is scheduled to be complete in May 2003. Additional funds are being requested to complete the data collection and qualitative components of the study.