Case-based audit and feedback around a decision aid improved antibiotic choice and duration for uncomplicated cystitis in primary care clinics

Abstract

ObjectivesThe objective of our study was to evaluate the impact of a multifaceted stewardship intervention on adherence to the evidence-based practice guidelines on treatment of uncomplicated cystitis in primary care. We hypothesised that our intervention would increase guideline adherence in terms of antibiotic choice and duration of treatment.DesignA preintervention and postintervention comparison with a contemporaneous control group was performed. During the first two study periods, we obtained baseline data and performed interviews exploring provider prescribing decisions for cystitis at both clinics. During the third period in the intervention clinic only, the intervention included a didactic lecture, a decision algorithm and audit and feedback. We used a difference-in-differences analysis to determine the effects of our intervention on the outcome and guideline adherence to antibiotic choice and duration.SettingTwo family medicine clinics (one intervention and one control) were included.ParticipantsAll female patients with uncomplicated cystitis attending the study clinics between 2016 and 2019.ResultsOur sample included 932 visits representing 812 unique patients with uncomplicated cystitis. The proportion of guideline-adherent antibiotic regimens increased during the intervention period (from 33.2% (95% CI 26.9 to 39.9) to 66.9% (95% CI 58.4 to 74.6) in the intervention site and from 5.3% (95% CI 2.3 to 10.1) to 17.0% (95% CI 9.9 to 26.6) in the control site). The increase in guideline adherence was greater in the intervention site compared with the control site with a difference-in-differences of 22 percentage points, p=0.001.ConclusionA multifaceted intervention increased guideline adherence for antibiotic choice and duration in greater magnitude than similar trends at the control site. Future research is needed to facilitate scale-up and sustainability of case-based audit and feedback interventions in primary care.

Improved management of cystitis in primary care following the implementation of a simple multifaceted intervention

“…Low-intensity multifaceted interventions have shown to be effective in improving the management of cystitis at different levels of care. 26 , 27 Training sessions and the availability of infographics with summarised information on the management of cystitis together with feedback to professionals are the most widely used strategies. We observed a global percentage of adaptation to the recommendations of 34% after our intervention; however, this result is slightly lower than that observed in other studies which achieved an improvement of 41% after carrying out the multifaceted intervention.…”

“…We observed a global percentage of adaptation to the recommendations of 34% after our intervention; however, this result is slightly lower than that observed in other studies which achieved an improvement of 41% after carrying out the multifaceted intervention. 27 Different factors may have influenced these results. In our setting, the primary care PROA programme has recently been created and is still in a consolidation phase.…”