Impact of a Multidisciplinary Intervention on Antibiotic Use for Nursing Home-Acquired Pneumonia
Impact of a Multidisciplinary Intervention on Antibiotic Use for Nursing Home-Acquired Pneumonia
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DOI：
10.1016/j.amjopharm.2011.09.009
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发表时间：
2011-12-01
期刊：
影响因子：
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通讯作者：
Hutt, Evelyn
中科院分区：
文献类型：
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作者：
Linnebur, Sunny A.;Fish, Douglas N.;Hutt, Evelyn
目的：本研究的目的是评估一项多学科干预措施的影响，其中包括针对国家养老院获得性肺炎(NHAP)指南的遵守情况。方法：这项准实验研究评估了为期两年的多方面、多学科干预措施的效果。干预措施发生在科罗拉多州的8个NHS；堪萨斯州和密苏里州的8个NHS作为对照。干预措施包括(1)为护士提供教育课程，以提高对NHAP症状的认识和及时治疗；(2)药剂师向临床医生提供有关诊断和处方实践的学术细节。结果：干预组共发生NHAP 549例，对照组574例。与基线相比，干预组有1个设施在遵守最佳抗生素使用指南方面有显著改善(P=0.007)，而对照组没有设施改善。干预后NHS患者对最佳抗生素使用的平均依从性得分从60%上升到66%，而对照组从32%上升到39%(P=0.3)。NHS干预组患者在确诊后4小时内对推荐使用抗生素的平均依从性从57%上升到75%，而对照组则从38%下降到31%(P=0.0003)。在关于最佳抗生素使用时间的指南遵守方面，干预和对照NHS之间没有区别。结论：这项多方面的研究能够反复提醒护理人员及时使用抗生素的重要性，这与其与临床医生有限的学术细节互动形成了对比。干预措施中的这种差异可能解释了干预措施对抗生素指南依从性的不同影响。(我是J Geriatr Pharmacore。2011；9：442-450)(C)2011 Elsevier HS Journal，Inc.保留所有权利。
Background: Academic detailing in nursing homes (NHs) has been shown to improve drug use patterns and adherence to guidelines.Objective: The purpose of this study was to evaluate the impact of a multidisciplinary intervention that included academic detailing on adherence to national nursing home acquired pneumonia (NHAP) guidelines related to use of antibiotics.Methods: This quasi-experimental study evaluated the effects of a 2-year multifaceted and multidisciplinary intervention targeting implementation of national evidence-based guidelines for NHAP. Interventions took place in 8 NHs in Colorado; 8 NHs in Kansas and Missouri served as controls. Interventions included (1) educational sessions for nurses to improve recognition and timely treatment of NHAP symptoms and (2) academic detailing to clinicians by pharmacists regarding diagnostic and prescribing practices. Differences in antibiotic use between groups were compared after 2 intervention years relative to baseline.Results: A total of 549 episodes of NHAP were evaluated in the intervention group and 574 in the control group. Compared with baseline, 1 facility in the intervention group significantly improved in guideline adherence for optimal antibiotic use (P = 0.007), whereas no facilities in the control group improved. The mean adherence score for optimal antibiotic use in intervention NHs increased from 60% to 66%, whereas the control NHs increased from 32% to 39% (P = 0.3). Mean adherence to guidelines recommending antibiotic use within 4 hours of NHAP diagnosis increased from 57% to 75% in intervention NHs but decreased from 38% to 31% in control NHs (P = 0.0003 for difference). There was no difference between intervention and control NHs for guideline adherence regarding optimal duration of antibiotic use.Conclusions: The ability of this multifaceted study to repeatedly remind nursing staff of the importance of timely antibiotic administration contrasts with its limited academic detailing interaction with clinicians. This difference within the intervention may explain the differential impact of the intervention on antibiotic guideline adherence. (Am J Geriatr Pharmacother. 2011;9:442-450) (C) 2011 Elsevier HS Journals, Inc. All rights reserved.