Effect of tailored antibiotic stewardship programmes on the appropriateness of antibiotic prescribing in nursing homes

Buul, Laura W van; Steen, Jenny T. van der; Achterberg, Wilco P.; Schellevis, F.G.; Essink, R.T.G.M.; Greeff, Sabine C. de; Natsch, Stephanie; Sloane, Philip D.; Zimmerman, Sheryl; Twisk, Jos W. R.; Veenhuizen, Ruth B.; Hertogh, Cees M.P.M.

doi:10.1093/jac/dkv051

Cited by 40 publications

(118 citation statements)

References 39 publications

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“…Altogether, 18 articles met the inclusion criteria (see flowchart in Figure 1). The study designs included pre and post (n = 9), [21][22][23][24][25][26][27][28][29] controlled pre and post (n = 4), 19,[30][31][32] cluster RCTs (n = 4), 20,[33][34][35] and patient-level RCT (n = 1). 36 More than half of the studies did not report or target a specific condition (n = 11) [20][21][22][23][24]27,29,[31][32][33]35 ; the number of study sites ranged from 1 to 46.…”

Section: Resultsmentioning

confidence: 99%

“…The study designs included pre and post (n = 9), [21][22][23][24][25][26][27][28][29] controlled pre and post (n = 4), 19,[30][31][32] cluster RCTs (n = 4), 20,[33][34][35] and patient-level RCT (n = 1). 36 More than half of the studies did not report or target a specific condition (n = 11) [20][21][22][23][24]27,29,[31][32][33]35 ; the number of study sites ranged from 1 to 46. Most studies were conducted in the United States (n = 12), 19,[21][22][23][24][25][26][27][28]30,32,36 followed by one each in Australia, 29 Canada, 35 Canada joint with United States, 34 Netherlands, 31 Sweden, 20 and the United Kingdom.…”

Section: Resultsmentioning

confidence: 99%

“…36 More than half of the studies did not report or target a specific condition (n = 11) [20][21][22][23][24]27,29,[31][32][33]35 ; the number of study sites ranged from 1 to 46. Most studies were conducted in the United States (n = 12), 19,[21][22][23][24][25][26][27][28]30,32,36 followed by one each in Australia, 29 Canada, 35 Canada joint with United States, 34 Netherlands, 31 Sweden, 20 and the United Kingdom. 33 The earliest publication year was 2001.…”

Section: Resultsmentioning

confidence: 99%

“…Most of the studies were multifaceted (n = 15), [19][20][21][23][24][25][28][29][30][31][32][33][34][35][36] and the number of intervention strategies used per study varied from one to seven, with a median of four ( Supplementary Table S2 provides a detailed list of strategies per study). The three most frequently used strategies were educational material (n = 13), [19][20][21][23][24][25][28][29][30][32][33][34]36 educational meetings (n = 12), 19,20,[23][24][25][28][29][30][31][32]34,36 and guideline implementation (n = 7). 20,23,[30][31][32]35,36 Six studies implemented an intervention to shift organizational cultur...…”

Section: Antimicrobial Stewardship Interventionsmentioning

confidence: 99%

“…The three most frequently used strategies were educational material (n = 13), [19][20][21][23][24][25][28][29][30][32][33][34]36 educational meetings (n = 12), 19,20,[23][24][25][28][29][30][31][32]34,36 and guideline implementation (n = 7). 20,23,[30][31][32]35,36 Six studies implemented an intervention to shift organizational culture [21][22][23]27,30,31 (eg, creating a new onsite infectious disease consultation service or implementing an ASP). Other strategies that have been implemented in LTCFs included audit and feedback (n = 5), 20,25,26,29,35 reminders (n = 5), 25,29,33,34,36 local opinion leader (n = 4),…”

Section: Antimicrobial Stewardship Interventionsmentioning

confidence: 99%

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Antimicrobial Stewardship Programs in Long‐Term Care Settings: A Meta‐Analysis and Systematic Review

Langford

Daneman

et al. 2018

J American Geriatrics Society

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BACKGROUND Antimicrobial stewardship programs have been established in hospitals, but less studied in long‐term care facilities (LTCFs), a setting with unique challenges related to patient populations and available resources. This systematic review sought to provide a comprehensive assessment of antimicrobial stewardship interventions implemented in LTCFs, using meta‐analysis to examine their impact on overall antimicrobial use. METHODS Electronic searches of MEDLINE, Embase, and CINAHL (1990 to July 2018) identified any antimicrobial stewardship interventions in LTCFs, with no restriction on patient population, study design, or outcomes. Intervention components were categorized using the Cochrane Effective Practice and Organization of Care taxonomy on implementation strategies. Random‐effects meta‐analysis used ratio of means to facilitate pooling of different metrics of antimicrobial use. RESULTS Eighteen studies (one randomized controlled trial [RCT], four cluster RCTs, four controlled pre/post studies, and nine uncontrolled pre/post studies) met inclusion, using 13 different antimicrobial stewardship intervention strategies; 15 studies used multifaceted (maximum, seven; median, four) interventions. The three most commonly implemented strategies were educational materials, educational meetings, and guideline implementation. Intervention labor intensity and resource requirements varied considerably among interventions. Meta‐analysis of 11 studies demonstrated that antimicrobial stewardship strategies were associated with a 14% reduction in overall antimicrobial use (95% confidence interval = −8% to −20%; P < .0001), with similar results by study design but high heterogeneity (I2 = 86%) for the uncontrolled pre/post study subgroup and no heterogeneity (I2 = 0%) for the cluster RCT and controlled pre/post study subgroups. Funnel plot analysis suggested publication bias, with a lack of publication of smaller studies showing increased antibiotic use. CONCLUSION Antimicrobial stewardship strategies implemented in long‐term care vary considerably in design and resource intensity, but collectively suggest potential to reduce antimicrobial use in this challenging setting. J Am Geriatr Soc 67:392–399, 2019.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Antimicrobial Stewardship Interventionsmentioning

confidence: 99%

Section: Antimicrobial Stewardship Interventionsmentioning

confidence: 99%

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Antimicrobial Stewardship Programs in Long‐Term Care Settings: A Meta‐Analysis and Systematic Review

Langford

Daneman

et al. 2018

J American Geriatrics Society

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Behavioral Approach to Appropriate Antimicrobial Prescribing in Hospitals

et al. 2017

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IMPORTANCE Inappropriate antimicrobial prescribing leads to antimicrobial resistance and suboptimal clinical outcomes. Changing antimicrobial prescribing is a complex behavioral process that is not often taken into account in antimicrobial stewardship programs.OBJECTIVE To examine whether an antimicrobial stewardship approach grounded in behavioral theory and focusing on preserving prescriber autonomy and participation is effective in improving appropriateness of antimicrobial prescribing in hospitals. DESIGN, SETTING, AND PARTICIPANTSThe Dutch Unique Method for Antimicrobial Stewardship (DUMAS) study was a prospective, stepped-wedge, participatory intervention study performed from October 1, 2011, through December 31, 2015. Outcomes were measured during a baseline period of 16 months and an intervention period of 12 months. The study was performed at 7 clinical departments (2 medical, 3 surgical, and 2 pediatric) in a tertiary care medical center and a general teaching hospital in the Netherlands. Physicians prescribing systemic antimicrobial drugs for any indication for patients admitted to the participating departments during the study period were included in the study. INTERVENTIONSWe offered prescribers a free choice of how to improve their antimicrobial prescribing. Prescribers were stimulated to choose interventions with higher potential for success based on a root cause analysis of inappropriate prescribing.MAIN OUTCOMES AND MEASURES Appropriateness of antimicrobial prescriptions was determined using a validated approach based on guideline adherence and motivated guideline deviation and measured with repeated point prevalence surveys (6 per year). Appropriateness judgment was masked for the study period. Antimicrobial consumption was extracted from pharmacy records and measured as days of therapy per admission. We used linear and logistic mixed-model regression analysis to model outcomes over time.RESULTS A total of 1121 patient cases with 700 antimicrobial prescriptions were assessed during the baseline period and 882 patient cases with 531 antimicrobial prescriptions during the intervention period. The mean antimicrobial appropriateness increased from 64.1% at intervention start to 77.4% at 12-month follow-up (+13.3%; relative risk, 1.17; 95% CI, 1.04-1.27), without a change in slope. No decrease in antimicrobial consumption was found.CONCLUSIONS AND RELEVANCE Use of a behavioral approach preserving prescriber autonomy resulted in an increase in antimicrobial appropriateness sustained for at least 12 months. The approach is inexpensive and could be easily transferable to various health care environments.

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Effect of a Standard vs Enhanced Implementation Strategy to Improve Antibiotic Prescribing in Nursing Homes

et al. 2019

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Key PointsQuestionDoes external facilitation improve adoption and effects of a complex antibiotic stewardship intervention in nursing homes?FindingsThis trial protocol describes a cluster-randomized hybrid type 2 effectiveness-implementation clinical trial of implementation of a multicomponent toolkit focused on improving the recognition and management of suspected urinary tract infection (UTI) in nursing homes. The trial seeks to evaluate whether delivery of external facilitation—coaching, collaborative learning, and peer comparison feedback—to implement this toolkit results in higher rates of toolkit adoption and reduced rates of urine testing and initiation of antibiotics for treatment of suspected UTI.MeaningIf successful, external facilitation could become an effective approach for improving spread and adoption of antibiotic stewardship interventions, as well as other quality improvement initiatives, in the nursing home setting.

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Effect of tailored antibiotic stewardship programmes on the appropriateness of antibiotic prescribing in nursing homes

Cited by 40 publications

References 39 publications

Antimicrobial Stewardship Programs in Long‐Term Care Settings: A Meta‐Analysis and Systematic Review

Antimicrobial Stewardship Programs in Long‐Term Care Settings: A Meta‐Analysis and Systematic Review

Behavioral Approach to Appropriate Antimicrobial Prescribing in Hospitals

Effect of a Standard vs Enhanced Implementation Strategy to Improve Antibiotic Prescribing in Nursing Homes

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