Improving Antibiotic Use in Acute Care Settings

描述：(由申请人提供)常见细菌中抗生素耐药性的出现和迅速上升正在对社区获得性感染的临床病程和卫生保健费用产生不利影响。由于抗生素耐药性模式与抗生素使用模式密切相关，减少不必要的抗生素使用是抗击抗生素耐药性努力的关键组成部分。在人类中，绝大多数不必要的抗生素处方都用于治疗具有病毒病原学的急性呼吸道感染(ARI)。尽管在美国，办公室医生开给ARI的抗生素处方率比1997年的峰值下降了约16%，但在急性护理环境(如急诊科和紧急护理中心)开出的抗生素的比例，占美国门诊抗生素处方的五分之一，在此期间仅略有下降(6%)。需要将干预研究的经验转化为办公室实践中的经验教训，以改善急性护理环境中抗生素的使用。 我们建议在8个退伍军人医院紧急护理诊所和8个非退伍军人医院急诊科进行一项由医生教育(教育研讨会、实践指南、绩效反馈和决策支持工具)和患者教育(候诊室打印和视听材料)组成的质量改进计划的随机对照试验。非退伍军人事务部研究地点将从现有的医院急诊科研究网络-EMNet中确定。弗吉尼亚紧急护理诊所的选址将从学术上附属的枢纽设施中选择。初步研究表明，对手指血样进行快速的床边C反应蛋白测试，可以帮助将患有社区获得性肺炎的风险非常低和风险很高的成年人分类。在研究的第二阶段，我们建议评估基于C反应蛋白的诊断算法对改善抗生素处方行为的增量影响。 具体目标1：评估多维(患者、系统、临床医生)干预对成人急性呼吸道感染患者适当使用抗生素的影响--确定影响在退伍军人医院和非退伍军人医院急性护理环境中成功转换的因素。 具体目标2：评估C反应蛋白快速诊断试验对成人急性咳嗽疾病抗生素使用的影响，当加入多维干预措施时。

DESCRIPTION: (Provided by the Applicant) The emergence and rapid rise in antibiotic resistance among common bacteria are adversely affecting the clinical course and health care costs of community-acquired infections. Because antibiotic resistance patterns are strongly correlated with antibiotic use patterns, reductions in unnecessary antibiotic use are critical components of efforts to combat antibiotic resistance. Among humans, the vast majority of unnecessary antibiotic prescriptions are used to treat acute respiratory tract infections (ARIs) that have a viral etiology. Although the rate of antibiotic prescribing for ARIs by office-based physicians in the U.S. has decreased about 16% from its peak in 1997, the rate of antibiotic prescribing in acute care settings (e.g., emergency departments and urgent care centers), which account for 1 in 5 ambulatory antibiotic prescriptions in the U.S., has shown only a modest decline (6%) during this period. Translation of lessons from intervention studies in office-based practices is needed to improve antibiotic use in acute care settings. We propose to conduct a randomized controlled trial of a quality improvement program consisting of physician education (educational seminar, practice guidelines, performance feedback, and decision support tools) and patient education (waiting room print and audiovisual materials) in 8 VA hospital urgent care clinics and 8 non-VA hospital emergency departments. Non VA study sites will be identified from an existing research network of hospital emergency departments--EMNet. VA urgent care clinic sites will be selected among academically affiliated hub facilities. Preliminary studies suggest that a rapid, bedside c-reactive protein test on a fingerstick blood specimen can help classify adults at very low risk, and at high risk, for community-acquired pneumonia. In a second phase of the study, we propose to evaluate the incremental impact of a c-reactive protein-based diagnostic algorithm to improve antibiotic prescribing behavior. Specific Aim 1: To evaluate the impact of a multidimensional (patient, system, clinician) intervention on appropriate antibiotic use for adults with acute respiratory tract infections-- identifying factors that influence successful translation across VA and non-VA hospital acute care settings. Specific Aim 2: To evaluate the impact of a rapid diagnostic test for c-reactive protein on antibiotic use for adults with acute cough illness when added to a multidimensional intervention.