Impact of a Personalized Audit and Feedback Intervention on Antibiotic Prescribing Practices for Outpatient Pediatric Community-Acquired Pneumonia

Diaz, Maria Carmen G.; Handy, Lori; Crutchfield, James H.; Cadilla, Adriana; Hossain, Jobayer; Werk, Lloyd N.

doi:10.1177/0009922820928054

Cited by 12 publications

(27 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Likewise, in an outpatient study from the USA, personalised audits and feedback interventions were able to steer antibiotic prescribing practices for 316 children with community-acquired pneumonia, which is a rather common but however limited problem [ 25 ]. The intervention group had fewer (5.9%) non-guideline-concordant antibiotics prescribed, compared to 21.4% in controls.…”

Section: Discussionmentioning

confidence: 99%

Cough and cold medicine prescription rates can be significantly reduced by active intervention

et al. 2021

View full text Add to dashboard Cite

Our aim was to construct and test an intervention programme to eradicate cough and cold medicine (CCM) prescriptions for children treated in a nationwide healthcare service company. The study was carried out in the largest private healthcare service company in Finland with a centralised electronic health record system allowing for real-time, doctor-specific practice monitoring. The step-by-step intervention consisted of company-level dissemination of educational materials to doctors and families, educational staff meetings, continuous monitoring of prescriptions, and targeted feedback. Outreach visits were held in noncompliant units. Finally, those physicians who most often prescribed CCM were directly contacted. During the intervention period (2017–2020), there were more than one million paediatric visits. Prescriptions of CCMs to children were completely eradicated in 41% of units and the total number of CCM prescriptions decreased from 6738 to 744 (89%). During the fourth intervention year, CCMs containing opioid derivatives were prescribed for only 0.2% of children aged < 2 years. The decrease in prescriptions was greatest in general practitioners (5.2 to 1.1%). In paediatricians, the prescription rates decreased from 1.5 to 0.2%. The annual costs of CCMs decreased from €183,996 to €18,899 (89.7%). For the intervention, the developers used 343 h and the attended doctors used 684 h of work time during the 4-year intervention. The costs used for developing, implementing, reporting, evaluating, communicating, and data managing formed approximately 11% of total intervention costs.Conclusion: The study showed that a nationwide systematic intervention to change cough medicine prescription practices is feasible and requires only modest financial investments. What is Known:• Cough and cold medicines (CCM) are not effective or safe, especially for children aged 6 years.• Although the use of CCMs has been declining, caregivers continue to administer CCMs to children, and some physicians still prescribe them even for preschool children. What is New:• A nationwide systematic intervention can significantly and cost effectively change CCM prescription habits of paediatricians, general practitioners, and other specialists.• Electronic health records provide additional tools for operative guideline implementation and real-time quality monitoring, including recommendations of useless or harmful treatments.

show abstract

Section: Discussionmentioning

confidence: 99%

Cough and cold medicine prescription rates can be significantly reduced by active intervention

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Although many guidelines have been published on how to treat LRTIs in children, very few studies have looked at how successfully the guidelines have been implemented 7,12,20 . One American study evaluated the impact of a 6‐month personalised audit and feedback programme on how primary care providers issued prescriptions for antibiotics for paediatric CAP 20 .…”

Section: Discussionmentioning

confidence: 99%

Antibiotic prescriptions for children with lower respiratory tract infections fell from 2014 to 2020, but misuse was still an issue

et al. 2022

View full text Add to dashboard Cite

Aim We evaluated main trends in antibiotic prescriptions for children with lower respiratory tract infection (LRTI) by Terveystalo, Finland's largest private healthcare company. Methods The study comprised of 89,359 children aged 0–17 years (57.2% boys) who visited Terveystalo primary care clinics from 2014 to 2020 with LRTI. The data were assessed by age, study year, location, the doctor's speciality and whether the diagnosis was bronchitis or community‐acquired pneumonia (CAP). Results There were gradual decreases in overall antibiotic prescription rates during the study period (37.0% in 2014 vs. 20.1% in 2020) and in prescribed macrolides (16.8% vs. 7.5%). Altogether, 31.3% of 72,737 children with bronchitis and 22.5% of those 16,622 with CAP‐received antibiotics. Macrolides were the most frequently prescribed antibiotics for bronchitis, at more than 40%, without any substantial relative decrease during the study. Costs of antibiotics increased from 2014 to 2016 and then decreased in line with the reduction in prescriptions. However, there was still a marked overuse of antibiotics, especially macrolides, for children with bronchitis. The relative use of amoxicillin for CAP increased from 41.4% to 65.4% between 2016 and 2020, in line with current guidelines. Conclusion Despite an overall reduction in prescribed antibiotics, some antibiotics were still overused, particularly macrolides for bronchitis.

show abstract

“…Recently, Zahlanie et al 63 showed that implementation of computerized treatment pathways in addition to personalized education sessions for primary care providers resulted in a substantial increase in the proportion of first‐line antibiotic prescriptions and reduction of antibiotic duration for children with a bacterial acute respiratory infection (ARI), and seeking medical attention in outpatient settings compared to the control group. A recently published report by Diaz et al 64 showed successful utilization of personalized scheduled audit and feedback to outpatient providers with the improvement of antibiotic prescriptions for community‐acquired pneumonia. Another research team was able to successfully reduce inappropriate use of oral third‐generation cephalosporins in children seen in ambulatory settings after implementation of intermittent education and audit with feedback from the antimicrobial stewardship team 65 .…”

Section: Benefits Of Antimicrobial Stewardship In Pediatricsmentioning

confidence: 99%

Antimicrobial stewardship program in pediatric medicine

Probst

Islamovic

Mirza

2021

Pediatric Investigation

View full text Add to dashboard Cite

The rising threats from antimicrobial resistance due to inappropriate utilization of antimicrobial agents in health care including the pediatric population has been a topic of concern at the global level for the last several decades. The antimicrobial stewardship program (ASP) is a multidisciplinary institutional initiative focusing primarily on the improvement of antimicrobial prescribing practices and limiting inappropriate use. ASPs play an important role in the implementation of healthcare strategies in pediatrics worldwide to reduce antimicrobial resistance. Many published reports demonstrate how adapted ASPs in pediatrics result in improvement of unnecessary antimicrobial utilization, decreasing drug resistance and treatment failure, minimization of adverse clinical outcomes, decreasing healthcare costs and hospital length of stay, and optimization of diagnostic strategies. However, some barriers in pediatric ASP still exist. This narrative review describes core elements of ASP, the impact of implemented ASPs on pediatric healthcare, and challenges of pediatric ASP as seen by the authors.

show abstract

Impact of a Personalized Audit and Feedback Intervention on Antibiotic Prescribing Practices for Outpatient Pediatric Community-Acquired Pneumonia

Cited by 12 publications

References 23 publications

Cough and cold medicine prescription rates can be significantly reduced by active intervention

Cough and cold medicine prescription rates can be significantly reduced by active intervention

Antibiotic prescriptions for children with lower respiratory tract infections fell from 2014 to 2020, but misuse was still an issue

Antimicrobial stewardship program in pediatric medicine

Contact Info

Product

Resources

About