Interventions to improve antibiotic prescribing practices for hospital inpatients

Davey, Peter; Brown, Erwin; Fenelon, Lynda; Finch, Roger; Gould, Ian M.; Hartman, Giles; Holmes, Alison; Ramsay, Craig R; Taylor, Eric; Wilcox, Mark H.; Wiffen, Philip J

doi:10.1002/14651858.cd003543.pub2

Cited by 148 publications

(61 citation statements)

References 96 publications

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“…36 Multiple methods to decrease inappropriate prescribing--including prescribing restrictions, reminders, printed materials, and feedback--have been evaluated, but it has been unclear which elements are most effective in influencing antimicrobial prescribing. 37,38 Our results demonstrate that widely disseminated and publicized national recommendations did substantially affect prescribing behavior in most areas and all practice settings and suggest that local public health messages can also modify their impact. However, many cases of gonorrhea were still treated with fluoroquinolones a year after the release of revised guidelines that no longer recommended fluoroquinolones.…”

Section: Discussionmentioning

confidence: 71%

Changes in Fluoroquinolone Use for Gonorrhea Following Publication of Revised Treatment Guidelines

et al. 2012

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Objectives. We evaluated the impact of revised national treatment recommendations on fluoroquinolone use for gonorrhea in selected states. Methods. We evaluated gonorrhea cases reported through the Sexually Transmitted Disease Surveillance Network as treated between July 1, 2006 and May 31, 2008, using interrupted time series analysis. Outcomes were fluoroquinolone treatment overall, by area, and by practice setting. Results. Of 16 126 cases with treatment dates in this period, 15 669 noted the medication used. After revised recommendations were released, fluoroquinolone use decreased abruptly overall (21.5%; 95% confidence interval [CI] = 15.9%, 27.2%), in most geographic areas evaluated, and in sexually transmitted disease clinics (28.5%; 95% CI = 19.0%, 37.9%). More gradual decreases were seen in primary care (8.6%; 95% CI = 2.6%, 14.6%), and in emergency departments, urgent care, and hospitals (2.7%; 95% CI = 1.7%, 3.7%). Conclusions. Fluoroquinolone use decreased after the publication of revised national guidelines, particularly in sexually transmitted disease clinics. Additional mechanisms are needed to increase the speed and magnitude of changes in prescribing in primary care, emergency departments, urgent care, and hospitals.

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Section: Discussionmentioning

confidence: 71%

Changes in Fluoroquinolone Use for Gonorrhea Following Publication of Revised Treatment Guidelines

et al. 2012

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“…However, the choice of metrics is complex and it is unclear at present if there is a “right” set of outcomes to be measured. Crude clinical outcomes that measure patient safety in terms of patient survival and length of stay are the most objective and practical, but they have thus far been infrequently assessed in publications on antimicrobial stewardship 13 , 40 , 41 . ASP has been shown to reduce the average length of hospital stay, 14-d re-infection rate and infection-related re-admissions 42 .…”

Section: Outcomes For Antimicrobial Stewardship Interventionsmentioning

confidence: 99%

“…ASP has been shown to reduce the average length of hospital stay, 14-d re-infection rate and infection-related re-admissions 42 . However, most of the studies assessing 30-d mortality have shown little or no difference, 40 , 42 and the reasons are clear—a large number of factors affect mortality (and length of hospitalization) and the independent effect of the usual antimicrobial stewardship interventions (i.e., choice of a narrower-spectrum antibiotic or shortened duration of therapy) is negligible. An expert panel recently proposed more specific metrics for clinical outcome such as mortality related to antimicrobial-resistant pathogens and “conservable days of therapy” (defined as avoided unnecessary treatment days based on widely accepted targets and benchmarks) instead of length of hospitalization 43 .…”

Section: Outcomes For Antimicrobial Stewardship Interventionsmentioning

confidence: 99%

Antimicrobial stewardship

Chung

Yeo

et al. 2013

Virulence

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Antimicrobial stewardship is an emerging field currently defined by a series of strategies and interventions aimed toward improving appropriate prescription of antibiotics in humans in all healthcare settings. The ultimate goal is the preservation of current and future antibiotics against the threat of antimicrobial resistance, although improving patient safety and reducing healthcare costs are important concurrent aims. Prospective audit and feedback interventions are probably the most widely practiced of all antimicrobial stewardship strategies. Although labor-intensive, they are more easily accepted by physicians compared with formulary restriction and preauthorization strategies and have a higher potential for educational opportunities. Objective evaluation of antimicrobial stewardship is critical for determining the success of such programs. Nonetheless, there is controversy over which outcomes to measure and there is a pressing need for novel study designs that can objectively assess antimicrobial stewardship interventions despite the limitations inherent in the structure of most such programs.

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“…It is pointed out that behaviour and social science research are under-utilized in the development of prescribing interventions (8). In hospital care several types of interventions were shown to be effective (57). However, it should be pointed out that the design of the studies as well as the selected outcome measures may affect the possibility to interpret and generalize the results.…”

Section: How Can Provider Behaviour In Relation To Antibiotics Change?mentioning

confidence: 99%

Understanding and changing human behaviour—antibiotic mainstreaming as an approach to facilitate modification of provider and consumer behaviour

Lundborg

Tamhankar

2014

Upsala Journal of Medical Sciences

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This paper addresses: 1) Situations where human behaviour is involved in relation to antibiotics, focusing on providers and consumers; 2) Theories about human behaviour and factors influencing behaviour in relation to antibiotics; 3) How behaviour in relation to antibiotics can change; and, 4) Antibiotic mainstreaming as an approach to facilitate changes in human behaviour as regards antibiotics. Influencing human behaviour in relation to antibiotics is a complex process which includes factors like knowledge, attitudes, social norms, socio-economic conditions, peer pressure, experiences, and bio-physical and socio-behavioural environment. Further, key concepts are often perceived in different ways by different individuals. While designing and implementing projects or programmes for behavioural change with respect to antibiotics for professionals or consumers it is helpful to consider theories or models of behaviour change, e.g. the ‘stages of change model’, including pre-contemplation, contemplation, preparation, action, and maintenance. People in different stages of change are susceptible to different behaviour modification strategies. Application of marketing principles to ‘global good’, so-called ‘social marketing’, to improve ‘welfare of the individual and society’ is gaining increased attention in public health. In conclusion, just providing correct knowledge is not sufficient although it is a pre-requisite for behaviour modification in the desired direction. We can never change the behaviour of any other human, but we can facilitate for others to change their own behaviour. One possibility is to implement ‘antibiotic mainstreaming’ as a potentially effective way for behaviour modification, i.e. to address consequences for maintaining effective antibiotics in all activities and decisions in society.

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Interventions to improve antibiotic prescribing practices for hospital inpatients

Cited by 148 publications

References 96 publications

Changes in Fluoroquinolone Use for Gonorrhea Following Publication of Revised Treatment Guidelines

Changes in Fluoroquinolone Use for Gonorrhea Following Publication of Revised Treatment Guidelines

Antimicrobial stewardship

Understanding and changing human behaviour—antibiotic mainstreaming as an approach to facilitate modification of provider and consumer behaviour

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