An audit and feedback intervention study increased adherence to antibiotic prescribing guidelines at a Norwegian hospital
An audit and feedback intervention study increased adherence to antibiotic prescribing guidelines at a Norwegian hospital
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DOI：
10.1186/s12879-016-1426-1
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发表时间：
2016-02-27
影响因子：
3.7
通讯作者：
Smabrekke, Lars
中科院分区：
文献类型：
--
作者：
Hogli, June Utnes;Garcia, Beate Hennie;Smabrekke, Lars
背景：适当的抗生素处方与良好的抗菌素耐药性（AMR）水平和临床结局相关。大多数关于抗生素处方的干预研究都来自AMR水平较高的环境。在挪威一家AMR水平较低的医院环境中，关于促进指南推荐的医院抗生素处方的干预措施的文献很少，需要。初步研究表明，根据指南开抗生素处方有改进的潜力。我们的目的是在挪威大学医院的呼吸内科促进社区获得性肺炎（CAP）和慢性阻塞性肺疾病急性加重（AECOPD）患者的适当抗生素处方。我们的具体目标是增加处方适当的经验性抗生素，减少高剂量的青霉素和减少总的治疗duty.Methods：我们进行了审计和反馈干预研究，结合最近出版的口袋版的国家临床实践指南的分布。我们纳入了因CAP或AECOPD出院并在住院期间处方抗生素的患者，排除了出现吸入、院内感染和合并感染的患者。干预前和干预后的时间分别为9个月和6个月。在内部教育会议上向科室医生口头提供反馈。为了探讨干预对适当经验抗生素和平均总治疗时间的影响，我们应用了前后分析（学生t检验）和中断时间序列（ITS）。结果：在干预前后，我们分别纳入了253名和155名患者。干预后，适当经验性抗生素的总体平均处方从61.7%增加到83.8%（P < 0.001），总体平均总治疗时间从11.2天减少到10.4天（P = 0.015），高剂量苄青霉素的处方从48.8%减少到38.6%（P = 0.125）。通过ITS，我们发现干预后6个月，对适当的经验性抗生素处方的影响增加并持续，而对治疗持续时间的影响则处于干预前水平。审计和反馈相结合，加上分发袖珍版指南建议，导致适当的经验性抗生素处方大幅增加，这是重要的，因为对AMR和临床结果有有利的影响。
Background: Appropriate antibiotic prescribing is associated with favourable levels of antimicrobial resistance (AMR) and clinical outcomes. Most intervention studies on antibiotic prescribing originate from settings with high level of AMR. In a Norwegian hospital setting with low level of AMR, the literature on interventions for promoting guideline-recommended antibiotic prescribing in hospital is scarce and requested. Preliminary studies have shown improvement potentials regarding antibiotic prescribing according to guidelines. We aimed to promote appropriate antibiotic prescribing in patients with community-acquired pneumonia (CAP) and acute exacerbations of chronic obstructive pulmonary disease (AECOPD) at a respiratory medicine department in a Norwegian University hospital. Our specific objectives were to increase prescribing of appropriate empirical antibiotics, reduce high-dose benzylpenicillin and reduce total treatment duration.Methods: We performed an audit and feedback intervention study, combined with distribution of a recently published pocket version of the national clinical practice guideline. We included patients discharged with CAP or AECOPD and prescribed antibiotics during hospital stay, and excluded those presenting with aspiration, nosocomial infection and co-infections. The pre-and post-intervention period was 9 and 6 months, respectively. Feedback was provided orally to the department physicians at an internal-educational meeting. To explore the effect of the intervention on appropriate empirical antibiotics and mean total treatment duration we applied before-after analysis (Student's t-test) and interrupted time series (ITS). We used Pearson's chi(2) to compare dose changes.Results: In the pre-and post-intervention period we included 253 and 155 patients, respectively. Following the intervention, overall mean prescribing of appropriate empirical antibiotics increased from 61.7 to 83.8 % (P < 0.001), overall mean total treatment duration decreased from 11.2 to 10.4 days (P = 0.015), and prescribing of high-dose benzylpenicillin decreased from 48.8 to 38.6 % (P = 0.125). With ITS we found that six months post-intervention, the effect on appropriate empirical antibiotic prescribing had increased and sustained, while the effect on treatment duration was at pre-intervention level.Conclusion: The combination of audit and feedback plus distribution of a pocket version of guideline recommendations led to a substantial increase in prescribing of appropriate empirical antibiotics, which is important due to favourable effect on AMR and clinical outcomes.