Assessing the Effectiveness AND Cost-Effectiveness of Audit and Feedback on Physician's Prescribing Indicators

Soleymani, Fatemeh; Rashidian, Arash; Dinarvand, Rassoul; Kebriaeezade, Abbas; Hosseini, Mona; Abdollahi, Mohammad

doi:10.1016/j.jval.2014.08.473

Cited by 3 publications

(3 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous studies in the region indicate that educational interventions alone have limited impact (49)(50)(51) but in many successful multifaceted interventions, educational components are included (9,17,52,53). Enablement interventions are speci c for intervening on factors that block the behavior change (8) Mitchie et al 2013).…”

Section: Discussionmentioning

confidence: 99%

Designing an Evidence-Based Behavior Change Strategy to Promote Antibiotic Use in Primary Healthcare in Gezira State, Sudan

Lohiniva

Elwali²,

Abuobaida³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Abuse of antibiotics is a major contributing factor to the emergence of antibiotic resistance (ABR) globally. Misuse of antibiotics is common also in Sudan. Objectives: The project aimed to develop a theory driven behavior change strategy based on local understanding of drivers of antibiotic use at primary healthcare settings in Gezira State in Sudan. Methods: The strategy was designed based on the Theoretical Domains Framework to identify behavioral barriers and the Behavior Change Wheel to select appropriate behavior change techniques The process included (1) a formative qualitative research study (2) a knowledge co-production workshop that utilized the results of the qualitative study and aimed to design a salient, legitimate and credible behavior change strategy identifying relevant behavior change techniques (BCTs) to overcome key barriers. Results: The main TDF domains that emerged from the discussions were knowledge of antibiotics and AMR, skills to answer patient demand on antibiotics, prescription habits and work exhaustion, social influences, intention to change prescription practices and environmental factors. The main TDF domains that emerged through discussions with patients were antibiotic use habits, social influences, professional role belief in capabilities and intention to change. The workshop discussions resulted in the selection of five BTCs that included education, training, modeling, enablement and persuasion. Conclusion: This study, using the TDF and BCW taxonomy, identified that antibiotic prescribing is influenced by social and contextual factors. Knowledge co- production offered real benefits in addressing these complexities to come up with a set of context appropriate behavior change interventions.

show abstract

Section: Discussionmentioning

confidence: 99%

Designing an Evidence-Based Behavior Change Strategy to Promote Antibiotic Use in Primary Healthcare in Gezira State, Sudan

Lohiniva

Elwali²,

Abuobaida³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Colon-Emeric 2007 120 Curtis 2005 121 Low risk of bias Unclear High risk of bias Curtis 2007 122 Desveaux 2016 77 Vellinga 2016 61 Eccles 2001 123 Elouafkaoui 2016 124 Eltayeb 2005 125 Ferguson 2003 126 Fiks 2017 127 Foster 2007 128 Foy 2004 129 French 2013 64 Fuller 2012 130 Gerber 2013 131 Lakshminarayan 2010 63 Leviton 1999 65 Liddy 2011 144 Lim 2018 145 Lomas 1991 67 MacLean 2009 102 Mayne 2014 146 Goff 2002 133 Guadagnoli 2000 68 Guldberg 2011 93 Hallsworth 2016 60 Hayashino 2016 134 Hayes 2002 69 Heller 2001 135 Hemkens 2017 136 Patel 2018 155 Peiris 2015 101 Persell 2016 62 Pimlott 2003 156 Pope 2010 91 Quinley 2004 72 Raasch 2000 157 Raja 2015 92 Rask 2001 78 Søndergaard 2003 161 Sandbaek 1999 158 Sauaia 2000 80 Schneider 2008 83 Butler 2012 118 Soleymani 2014 159 Søndergaard 2002 160 Soumerai 1998 79 Tjia 2015 164 Trietsch 2017…”

Section: Information About Others' Approvalmentioning

confidence: 99%

Social norms interventions to change clinical behaviour in health workers: a systematic review and meta-analysis

Cotterill

Tang

Powell

et al. 2020

Health Serv Deliv Res

View full text Add to dashboard Cite

Background A social norms intervention seeks to change the clinical behaviour of a target health worker by exposing them to the values, beliefs, attitudes or behaviours of a reference group or person. These low-cost interventions can be used to encourage health workers to follow recommended professional practice. Objective To summarise evidence on whether or not social norms interventions are effective in encouraging health worker behaviour change, and to identify the most effective social norms interventions. Design A systematic review and meta-analysis of randomised controlled trials. Data sources The following databases were searched on 24 July 2018: Ovid MEDLINE (1946 to week 2 July 2018), EMBASE (1974 to 3 July 2018), Cumulative Index to Nursing and Allied Health Literature (1937 to July 2018), British Nursing Index (2008 to July 2018), ISI Web of Science (1900 to present), PsycINFO (1806 to week 3 July 2018) and Cochrane trials (up to July 2018). Participants Health workers took part in the study. Interventions Behaviour change interventions based on social norms. Outcome measures Health worker clinical behaviour, for example prescribing (primary outcome), and patient health outcomes, for example blood test results (secondary), converted into a standardised mean difference. Methods Titles and abstracts were reviewed against the inclusion criteria to exclude any that were clearly ineligible. Two reviewers independently screened the remaining full texts to identify relevant papers. Two reviewers extracted data independently, coded for behaviour change techniques and assessed quality using the Cochrane risk-of-bias tool. We performed a meta-analysis and presented forest plots, stratified by behaviour change technique. Sources of variation were explored using metaregression and network meta-analysis. Results A total of 4428 abstracts were screened, 477 full texts were screened and findings were based on 106 studies. Most studies were in primary care or hospitals, targeting prescribing, ordering of tests and communication with patients. The interventions included social comparison (in which information is given on how peers behave) and credible source (which refers to communication from a well-respected person in support of the behaviour). Combined data suggested that interventions that included social norms components were associated with an improvement in health worker behaviour of 0.08 standardised mean differences (95% confidence interval 0.07 to 0.10 standardised mean differences) (n = 100 comparisons), and an improvement in patient outcomes of 0.17 standardised mean differences (95% confidence interval 0.14 to 0.20) (n = 14), on average. Heterogeneity was high, with an overall I 2 of 85.4% (primary) and 91.5% (secondary). Network meta-analysis suggested that three types of social norms intervention were most effective, on average, compared with control: credible source (0.30 standardised mean differences, 95% confidence interval 0.13 to 0.47); social comparison combined with social reward (0.39 standardised mean differences, 95% confidence interval 0.15 to 0.64); and social comparison combined with prompts and cues (0.33 standardised mean differences, 95% confidence interval 0.22 to 0.44). Limitations The large number of studies prevented us from requesting additional information from authors. The trials varied in design, context and setting, and we combined different types of outcome to provide an overall summary of evidence, resulting in a very heterogeneous review. Conclusions Social norms interventions are an effective method of changing clinical behaviour in a variety of health service contexts. Although the overall result was modest and very variable, there is the potential for social norms interventions to be scaled up to target the behaviour of a large population of health workers and resulting patient outcomes. Future work Development of optimised credible source and social comparison behaviour change interventions, including qualitative research on acceptability and feasibility. Study registration This study is registered as PROSPERO CRD42016045718. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 41. See the NIHR Journals Library website for further project information.

show abstract

“…Overuse of injections has become common concerns in many LMICs and may result in unexpected outcomes and resource wastage [37]. The restrictive-prescribing stewardship failed to make significant progress in regulating parenteral antibiotic use, though significant decline were found in the consumption of oral antibiotics.…”

Section: Comparison With Existing Literaturementioning

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

Preprint

View full text Add to dashboard Cite

Abstract 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. This study aimed to evaluate the effects of a restrictive-prescribing stewardship on antibiotic consumption in primary care so as to provideevidence-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) methodologywere 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 (declined by 32.58%) 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 of 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 an ascending 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 use of penicillins, cephalosporins and macrolides/lincosamides/streptogramins. However, the intervention effects were mixed. Stronger administrative regulation focusing on specific antibiotics, such as the third and fourth-generation cephalosporins, fluoroquinolones, broad-spectrum antibiotics and parenteral antibiotics, is in urgent need in the future.

show abstract

Assessing the Effectiveness AND Cost-Effectiveness of Audit and Feedback on Physician's Prescribing Indicators

Cited by 3 publications

References 0 publications

Designing an Evidence-Based Behavior Change Strategy to Promote Antibiotic Use in Primary Healthcare in Gezira State, Sudan

Designing an Evidence-Based Behavior Change Strategy to Promote Antibiotic Use in Primary Healthcare in Gezira State, Sudan

Social norms interventions to change clinical behaviour in health workers: a systematic review and meta-analysis

Effects of Restrictive-prescribing Stewardship on Antibiotic Consumption in Primary Care in China: An Interrupted Time Series Analysis, 2012-2017

Contact Info

Product

Resources

About