Improving fluoroquinolone use in the outpatient setting using a patient safety initiative

Jindai, Kazuaki; Goto, Michihiko; Mackay, Kimberly; Forrest, Graeme N.; Musuuza, Jackson; Safdar, Nasia; Pfeiffer, Christopher D.

doi:10.1017/ice.2018.169

Cited by 9 publications

(4 citation statements)

References 8 publications

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“…This approach could result in a more objective quantification of overall antimicrobial usage. 23 This study had several limitations. First, given the retrospective nature of the study, it is difficult to determine whether additional external factors other than the assessed interventions might have affected the study results.…”

Section: Discussionmentioning

confidence: 93%

“…In various antimicrobial stewardship interventions for providers and patients, collateral effects on control groups or unintended populations were not uncommon. 23,24 Because most primary care providers and pediatricians care for children in all age groups, collateral effects could explain the broader effect of the educational intervention. The implementation of financial incentives, in contrast, had been strictly limited to those aged 0-2 years; therefore, it is unlikely to influence prescription practice on the other age groups.…”

Section: Discussionmentioning

confidence: 99%

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Decline in oral antimicrobial prescription in the outpatient setting after nationwide implementation of financial incentives and provider education: An interrupted time-series analysis

Jindai

Itaya

Ogawa

et al. 2022

Infect. Control Hosp. Epidemiol.

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Objectives: To assess the impact of nationwide outpatient antimicrobial stewardship interventions in the form of financial incentives for providers and provider education when antimicrobials are deemed unnecessary for uncomplicated respiratory infections and acute diarrhea. Methods: We collected data from a large claims database from April 2013 through March 2020 and performed a quasi-experimental, interrupted time-series analysis. The outcome of interest was oral antimicrobial prescription rate defined as the number of monthly antimicrobial prescriptions divided by the number of outpatient visits each month. We examined the effects of financial incentive to providers (ie, targeted prescriptions for those aged ≤2 years) and provider education (ie, targeted prescriptions for those aged ≥6 years) on the overall antimicrobial prescription rates and how these interventions affected different age groups before and after their implementation. Results: In total, 21,647,080 oral antimicrobials were prescribed to 2,920,381 unique outpatients during the study period. At baseline, prescription rates for all age groups followed a downward trend throughout the study period. Immediately after the financial incentive implementation, substantial reductions in prescription rates were observed among only those aged 0–2 years (−47.5 prescriptions per 1,000 clinic visits each month; 95% confidence interval, −77.3 to −17.6; P = .003), whereas provider education immediately reduced prescription rates in all age groups uniformly. These interventions did not affect the long-term trend for any age group. Conclusion: These results suggest that the nationwide implementation of financial incentives and provider education had an immediate effect on the antimicrobial prescription but no long-term effect.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Decline in oral antimicrobial prescription in the outpatient setting after nationwide implementation of financial incentives and provider education: An interrupted time-series analysis

Jindai

Itaya

Ogawa

et al. 2022

Infect. Control Hosp. Epidemiol.

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“…Notably, this intervention occurred after the improvement team visited CBOCs, meeting and interviewing providers to learn about processes and barriers at each site, which built rapport and made individualised reviews easier. Comparison feedback emails have been shown to be both ineffective 35 and effective 24 25 36-39 in increasing provider guideline adherence. Although there was some reduction in prescribing with implementation of feedback emails, the reduction was not sustained once the intervention was removed.…”

Section: Discussionmentioning

confidence: 99%

Operationalising outpatient antimicrobial stewardship to reduce system-wide antibiotics for acute bronchitis

et al. 2021

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BackgroundAntibiotics are not recommended for treatment of acute uncomplicated bronchitis (AUB), but are often prescribed (85% of AUB visits within the Veterans Affairs nationally). This quality improvement project aimed to decrease antibiotic prescribing for AUB in community-based outpatient centres from 65% to <32% by April 2020.MethodsFrom January to December 2018, community-based outpatient clinics’ 6 months’ average of prescribed antibiotics for AUB and upper respiratory infections was 63% (667 of 1054) and 64.6% (314 of 486) when reviewing the last 6 months. Seven plan–do–study–act (PDSA) cycles were implemented by an interprofessional antimicrobial stewardship team between January 2019 and March 2020. Balancing measures were a return patient phone call or visit within 4 weeks for the same complaint. Χ2 tests and statistical process control charts using Western Electric rules were used to analyse intervention data.ResultsThe AUB antibiotic prescribing rate decreased from 64.6% (314 of 486) in the 6 months prior to the intervention to 36.8% (154 of 418) in the final 6 months of the intervention. No change was seen in balancing measures. The largest reduction in antibiotic prescribing was seen after implementation of PDSA 6 in which 14 high prescribers were identified and targeted for individualised reviews of encounters of patients with AUB with an antimicrobial steward.ConclusionsOperational implementation of successful stewardship interventions is challenging and differs from the traditional implementation study environment. As a nascent outpatient stewardship programme with limited resources and no additional intervention funding, we successfully reduced antibiotic prescribing from 64.6% to 36.8%, a reduction of 43% from baseline. The most success was seen with targeted education of high prescribers.

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“…Consistent with our findings, Rodrigues AT et al [38] found that relative prescription of fluoroquinolones showed no changes after intervention, which were attributed to the association of these prescriptions in primary care with disease condition and patient's age, making it more difficult to change prescribing behaviors in such cases. Jindai K et al [39] discovered an initial reduction on fluoroquinolone prescribing rate after implementing fluoroquinolone safety initiative but was not sustained later, calling for sustainable strategies. Future stewardship should not only specifically target fluoroquinolone use but also combine ongoing approaches to enhance the sustainability of intervention.…”

Section: Strengths and Limitations Of The Studymentioning

confidence: 99%

Effects of restrictive-prescribing stewardship on antibiotic consumption in primary care in China: an interrupted time series analysis, 2012–2017

Wang

Tang

Liu

et al. 2020

Antimicrob Resist Infect Control

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Background The overuse of antibiotics has been a major public health problem worldwide, especially in low- and middle- income countries (LMIC). However, there are few policies specific to antibiotic stewardship in primary care and their effectiveness are still unclear. A restrictive-prescribing stewardship targeting antibiotic use in primary care has been implemented since December 2014 in Hubei Province, China. This study aimed to evaluate the effects of the restrictive-prescribing stewardship on antibiotic consumption in primary care so as to provide evidence-based suggestions for prudent use of antibiotics. Methods Monthly antibiotic consumption data were extracted from Hubei Medical Procurement Administrative Agency (HMPA) system from Sept 1, 2012, to Aug 31, 2017. Quality Indictors of European Surveillance of Antimicrobial Consumption (ESAC QIs) combined with Anatomical Therapeutic Chemical (ATC) classification codes and DDD per 1000 inhabitants per day (DID) methodology were applied to measure antibiotic consumption. An interrupted time series analysis was performed to evaluate the effects of restrictive-prescribing stewardship on antibiotic consumption. Results Over the entire study period, a significant reduction (32.58% decrease) was observed in total antibiotic consumption, which declined immediately after intervention (coefficient = − 2.4518, P = 0.005) and showed a downward trend (coefficient = − 0.1193, P = 0.017). Specifically, the use of penicillins, cephalosporins and macrolides/lincosamides/streptogramins showed declined trends after intervention (coefficient = − 0.0553, P = 0.035; coefficient = − 0.0294, P = 0.037; coefficient = − 0.0182, P = 0.003, respectively). An immediate decline was also found in the contribution of β-lactamase-sensitive penicillins to total antibiotic use (coefficient = − 2.9126, P = 0.001). However, an immediate increase in the contribution of third and fourth-generation cephalosporins (coefficient = 5.0352, P = 0.005) and an ascending trend in the contribution of fluoroquinolones (coefficient = 0.0406, P = 0.037) were observed after intervention. The stewardship led to an immediate increase in the ratio between broad- and narrow-spectrum antibiotic use (coefficient = 1.8747, P = 0.001) though they both had a significant downward trend (coefficient = − 0.0423, P = 0.017; coefficient = − 0.0223, P = 0.006, respectively). An immediate decline (coefficient = − 1.9292, P = 0.002) and a downward trend (coefficient = − 0.0815, P = 0.018) were also found in the oral antibiotic use after intervention, but no significant changes were observed in the parenteral antibiotic use. Conclusions Restrictive-prescribing stewardship in primary care was effective in reducing total antibiotic consumption, especially the use of penicillins, cephalosporins and macrolides/lincosamides/streptogramins. However, the intervention effects were limited regarding the use of combinations of penicillins with ß-lactamase inhibitors, the third and fourth-generation cephalosporins, fluoroquinolones and parenteral antibiotics. Stronger administrative regulations focusing on specific targeted antibiotics, especially the use of broad-spectrum antibiotics and parenteral antibiotics, are in urgent need in the future.

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Improving fluoroquinolone use in the outpatient setting using a patient safety initiative

Cited by 9 publications

References 8 publications

Decline in oral antimicrobial prescription in the outpatient setting after nationwide implementation of financial incentives and provider education: An interrupted time-series analysis

Decline in oral antimicrobial prescription in the outpatient setting after nationwide implementation of financial incentives and provider education: An interrupted time-series analysis

Operationalising outpatient antimicrobial stewardship to reduce system-wide antibiotics for acute bronchitis

Effects of restrictive-prescribing stewardship on antibiotic consumption in primary care in China: an interrupted time series analysis, 2012–2017

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