Community-acquired pneumonia: why aren't national antibiotic guidelines followed?

Almatar, Maher; Peterson, Gregory M.; Thompson, Angus; McKenzie, Duncan; Anderson, Tara

doi:10.1111/ijcp.12538

Cited by 18 publications

(21 citation statements)

References 21 publications

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“…Due to irrational prescribing practices, the rate of multiresistant bacteria has dramatically increased over the last years, and it is more and more challenging to recommend effective empiric antibiotic therapy [3,4]. Despite these circumstances, medical doctors often continue to prescribe antibiotics unreasonably in their daily routine [5,6].…”

Section: Introductionmentioning

confidence: 99%

A clinical decision support system improves antibiotic therapy for upper urinary tract infection in a randomized single-blinded study

Neugebauer

Ebert

Vogelmann

2020

BMC Health Serv Res

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Background: Due to increasing bacterial resistance rates choosing a correct empiric antibiotic therapy is getting more and more complex. Often medical doctors use information tools to make the right treatment choice. Methods: One hundred sixty six participants (77 medical doctors and 89 medical students) were asked to provide a diagnosis and antibiotic therapy in a simple fictive paper case of upper urinary tract infection (UTI) in a randomized single-blinded study. Participants were randomized to one of four information tools they were allowed to use in the study or control: 1. free internet access, 2. pharmaceutical pocket guide, 3. pocket guide antibiotic therapy, 4. clinical decision support system (CDSS), and control (no information tool). The CDSS was designed for the study. The adherence to the national German UTI guideline was evaluated.Results: Only 27.1% (n = 45/166) provided a correct diagnosis of upper UTI and 19.4% (n = 32/166) an antibiotic treatment recommended by national German treatment guidelines indicating their need for information tools. This result was not significantly different between medical doctors and medical students, residents and medical specialists or level of working experience. Using CDSS improved results significantly compared to conventional tools (diagnosis 57.1%; treatment recommendation 40.5%; p < 0,01). Processing time was not different between the use of CDSS and conventional information tools. CDSS users based their decision making on their assigned information tool more than users of conventional tools (73.8% vs. 48.0%; p < 0.01). Using CDSS improved the confidence of participants in their recommendation significantly compared to conventional tools (p < 0.01). Conclusions: Our study suggests that medical professionals require information tools in diagnosing and treating a simple case of upper UTI correctly. CDSS appears to be superior to conventional tools as an information source.

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Section: Introductionmentioning

confidence: 99%

A clinical decision support system improves antibiotic therapy for upper urinary tract infection in a randomized single-blinded study

Neugebauer

Ebert

Vogelmann

2020

BMC Health Serv Res

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“…35,60,68 The literature reviewed suggests that use of guidelines can be strengthened further through active senior support, better communication to health professionals including junior doctors and ongoing evaluation. 43,60,62,103,106 Apart from the use of guidelines for decision support, some articles also advocate the use of information technology to improve prescribing and decrease medication errors. 57,135,186 However, such arguments need to be treated with caution to avoid treating technology as a silver bullet.…”

Section: Antimicrobial Prescribing Support Aidsmentioning

confidence: 99%

Interventions to improve antimicrobial prescribing of doctors in training (IMPACT): a realist review

Papoutsi

Mattick

Pearson

et al. 2018

Health Serv Deliv Res

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BackgroundInterventions to improve the antimicrobial prescribing practices of doctors have been implemented widely to curtail the emergence and spread of antimicrobial resistance, but have been met with varying levels of success.ObjectivesThis study aimed to generate an in-depth understanding of how antimicrobial prescribing interventions ‘work’ (or do not work) for doctors in training by taking into account the wider context in which prescribing decisions are enacted.DesignThe review followed a realist approach to evidence synthesis, which uses an interpretive, theory-driven analysis of qualitative, quantitative and mixed-methods data from relevant studies.SettingPrimary and secondary care.ParticipantsNot applicable.InterventionsStudies related to antimicrobial prescribing for doctors in training.Main outcome measuresNot applicable.Data sourcesEMBASE (via Ovid), MEDLINE (via Ovid), MEDLINE In-Process & Other Non-Indexed Citations (via Ovid), PsycINFO (via Ovid), Web of Science core collection limited to Science Citation Index Expanded (SCIE) and Conference Proceedings Citation Index – Science (CPCI-S) (via Thomson Reuters), Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, the Health Technology Assessment (HTA) database (all via The Cochrane Library), Applied Social Sciences Index and Abstracts (ASSIA) (via ProQuest), Google Scholar (Google Inc., Mountain View, CA, USA) and expert recommendations.Review methodsClearly bounded searches of electronic databases were supplemented by citation tracking and grey literature. Following quality standards for realist reviews, the retrieved articles were systematically screened and iteratively analysed to develop theoretically driven explanations. A programme theory was produced with input from a stakeholder group consisting of practitioners and patient representatives.ResultsA total of 131 articles were included. The overarching programme theory developed from the analysis of these articles explains how and why doctors in training decide to passively comply with or actively follow (1) seniors’ prescribing habits, (2) the way seniors take into account prescribing aids and seek the views of other health professionals and (3) the way seniors negotiate patient expectations. The programme theory also explains what drives willingness or reluctance to ask questions about antimicrobial prescribing or to challenge the decisions made by seniors. The review outlines how these outcomes result from complex inter-relationships between the contexts of practice doctors in training are embedded in (hierarchical relationships, powerful prescribing norms, unclear roles and responsibilities, implicit expectations about knowledge levels and application in practice) and the mechanisms triggered in these contexts (fear of criticism and individual responsibility, reputation management, position in the clinical team and appearing competent). Drawing on these findings, we set out explicit recommendations for optimal tailoring, design and implementation of antimicrobial prescribing interventions targeted at doctors in training.LimitationsMost articles included in the review discussed hospital-based, rather than primary, care. In cases when few data were available to fully capture all the nuances between context, mechanisms and outcomes, we have been explicit about the strength of our arguments.ConclusionsThis review contributes to our understanding of how antimicrobial prescribing interventions for doctors in training can be better embedded in the hierarchical and interprofessional dynamics of different health-care settings.Future workMore work is required to understand how interprofessional support for doctors in training can contribute to appropriate prescribing in the context of hierarchical dynamics.Study registrationThis study is registered as PROSPERO CRD42015017802.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…Based on these findings, many score systems are defined yet. However, as there is no consensus about all of the factors that influence the mortality, none of the mentioned score systems are followed strictly in clinical practice . So far, the prognostic value of factors associated with deprivation had not been extensively investigated in CAP.…”

Section: Introductionmentioning

confidence: 99%

“…However, as there is no consensus about all of the factors that influence the mortality, none of the mentioned score systems are followed strictly in clinical practice. 4 So far, the prognostic value of factors associated with deprivation had not been extensively investigated in CAP. Given the importance of this issue, this study has been performed in a year period in a tertiary care teaching hospital in a deprived region.…”

Section: Introductionmentioning

confidence: 99%

Poverty as an independent risk factor for in-hospital mortality in community-acquired pneumonia: A study in a developing country population

et al. 2018

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Community-acquired pneumonia: why aren't national antibiotic guidelines followed?

Abstract: Adherence to CAP treatment guidelines was poor, especially in patients with mild disease. Prescribing was mainly influenced by senior doctors. Efforts to improve compliance with CAP treatment guidelines should consider the potential barriers that hinder adherence.

Cited by 18 publications

References 21 publications

A clinical decision support system improves antibiotic therapy for upper urinary tract infection in a randomized single-blinded study

A clinical decision support system improves antibiotic therapy for upper urinary tract infection in a randomized single-blinded study

Interventions to improve antimicrobial prescribing of doctors in training (IMPACT): a realist review

Poverty as an independent risk factor for in-hospital mortality in community-acquired pneumonia: A study in a developing country population

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