Quantitative evaluation of a clinical intervention aimed at changing prescriber behaviour in response to new guidelines

Doyon, Sophie; Perreault, Mélissa; Marquis, Christopher; Gauthier, Josianne; Lebel, Denis; Bailey, Benoît; Collin, Johanne; Bussières, Jean-François

doi:10.1111/j.1365-2753.2009.01259.x

Cited by 12 publications

(21 citation statements)

References 28 publications

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“…1 Flowchart of the study selection process 94-107, 110-114, 116-121, 123-135, 137, 138, 141-143, 147, 148]; sixty-one of these were studies with a single intervention, mainly with an audit and feedback strategy(19/61, 31.1%) [53, 56-58, 62, 64, 67-71, 74, 76, 82-86, 89, 91, 92, 94, 107, 110, 111, 113, 120, 121, 123, 127, 132, 134, 135, 138, 141, 142, 147]. Eighteen papers (18/113, 15.9%)[40-42, 51, 54, 60, 71, 85, 87, 91, 98, 105, 106, 125, 135, 136, 138, 142] showed an increase in compliance among prescribing physicians; half of the papers analysing this outcome were from USA and Canada (10/18, 55.5%), and the main ASPs adopted were guidelines (9/34, 26.5%)[40,42,54,60,85,87,91,106,125,142], doctors education (5/34, 14.7%)[54,91,98,138,142] and other not common ASPs such as antibiotic order set[42,51], and checklists[87,91]. Sixteen of the included studies[16/113, 14.2% in total; 7/16 (43.7%) from USA, 6/16 (37.5%) from Asia and the rest (18.7%) from Europe] quantified cost savings related to the intervention[39,49,52,64,66,69,73,86,89,92,97,101,102,[122][123][124].…”

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confidence: 99%

Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review

Donà

Barbieri

Daverio

et al. 2020

Antimicrob Resist Infect Control

108

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Background: Antibiotics are the most common medicines prescribed to children in hospitals and the community, with a high proportion of potentially inappropriate use. Antibiotic misuse increases the risk of toxicity, raises healthcare costs, and selection of resistance. The primary aim of this systematic review is to summarize the current state of evidence of the implementation and outcomes of pediatric antimicrobial stewardship programs (ASPs) globally. Methods: MEDLINE, Embase and Cochrane Library databases were systematically searched to identify studies reporting on ASP in children aged 0-18 years and conducted in outpatient or in-hospital settings. Three investigators independently reviewed identified articles for inclusion and extracted relevant data. Results: Of the 41,916 studies screened, 113 were eligible for inclusion in this study. Most of the studies originated in the USA (52.2%), while a minority were conducted in Europe (24.7%) or Asia (17.7%). Seventy-four (65.5%) studies used a before-and-after design, and sixteen (14.1%) were randomized trials. The majority (81.4%) described in-hospital ASPs with half of interventions in mixed pediatric wards and ten (8.8%) in emergency departments. Only sixteen (14.1%) studies focused on the costs of ASPs. Almost all the studies (79.6%) showed a significant reduction in inappropriate prescriptions. Compliance after ASP implementation increased. Sixteen of the included studies quantified cost savings related to the intervention with most of the decreases due to lower rates of drug administration. Seven studies showed an increased susceptibility of the bacteria analysed with a decrease in extended spectrum beta-lactamase producers E. coli and K. pneumoniae; a reduction in the rate of P. aeruginosa carbapenem resistance subsequent to an observed reduction in the rate of antimicrobial days of therapy; and, in two studies set in outpatient setting, an increase in erythromycin-sensitive S. pyogenes following a reduction in the use of macrolides. Conclusions: Pediatric ASPs have a significant impact on the reduction of targeted and empiric antibiotic use, healthcare costs, and antimicrobial resistance in both inpatient and outpatient settings. Pediatric ASPs are now widely implemented in the USA, but considerable further adaptation is required to facilitate their uptake in Europe, Asia, Latin America and Africa.

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mentioning

confidence: 99%

Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review

Donà

Barbieri

Daverio

et al. 2020

Antimicrob Resist Infect Control

108

View full text Add to dashboard Cite

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“…Use of, and adherence to, guidelines either implemented at high level or locally created de novo improved compliance to practice recommendations such as time to administration, prescription, and duration of antibiotics [44][45][46][47] training, the evaluation of prescribing patterns and recommendations by a stewardship team, and the general presence of ASP programs in Canadian ICUs [48][49][50]. All three studies showed improvements in decision-making behaviors of practitioners, decreased use of broad-spectrum antibiotics, and increased patient knowledge on appropriate use, respectively [48][49][50].…”

Section: Mesolevel Interventionsmentioning

confidence: 99%

In-Hospital Macro-, Meso-, and Micro-Drivers and Interventions for Antibiotic Use and Resistance: A Rapid Evidence Synthesis of Data from Canada and Other OECD Countries

Mastrangelo

Hajizadeh

Piggott

et al. 2022

Canadian Journal of Infectious Diseases and Medical Microbiolog

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Hospitals continue to face challenges in reducing incorrect antibiotic use due to social and cultural factors at the level of the health system, the care facility, the provider, and the patient. The objective of this paper is to highlight the social and cultural drivers of antimicrobial use and resistance and targeted interventions for secondary and tertiary care settings in Canada and other OECD countries. This paper is an extension of the synthesis conducted for the Public Health Agency of Canada’s 2019 Spotlight Report: Preserving Antibiotics Now and Into the Future. We conducted a systematic review with a few modifications to meet rapid timelines. We conducted a search in Ovid MEDLINE and McMaster University’s evidence databases for systematic reviews and then for individual Canadian studies. To cast a wider net, we searched OECD organization websites and screened reference lists from systematic reviews. We synthesized the evidence narratively and categorized the evidence into macro-, meso-, and microlevel. A total of 70 studies were (a) from OCED countries and summarized evidence of potential sociocultural antimicrobial resistance and use barriers or facilitators and/or interventions addressing these challenges; (b) systematic reviews with 50% of included studies that are situated in secondary and tertiary settings; and (c) published in Canada’s two official languages, English and French. We found that hospital structures and policies may influence antibiotic utilization and variations in antimicrobial management. Microlevel factors may sway inappropriate prescribing among clinicians. The amount and type of antibiotics used may affect resistance rates. Interventions were mainly comprised of antibiotic stewardship and training that modify clinician behavior and that educate patients and carers. This evidence synthesis illustrates the various drivers of, and interventions for, antimicrobial use and resistance at the macro-, meso-, and microlevel in secondary and tertiary settings. We demonstrate that upstream drivers may lead to downstream events that influence antimicrobial resistance.

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“…For reasons of space, however, it has not been possible, this year, to include such a detailed overview, given that essentially all of the 350 budgeted pages of this issue – our biggest thematic edition to date – have been taken up by the very large number and types of papers accepted by the JECP and which form the current work. This year's thematic issue adopts the structure of those published previously [1–12], beginning with theoretical and philosophical argumentation [13–34] and progressing to original data‐rich, experimental and associated studies [35–65].…”

Section: Introductionmentioning

confidence: 99%

Towards a Medicine of the Whole Person – knowledge, practice and holism in the care of the sick

Miles

2009

Evaluation Clinical Practice

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Quantitative evaluation of a clinical intervention aimed at changing prescriber behaviour in response to new guidelines

Abstract: Guideline dissemination for the management of acute community-acquired pneumonia significantly increased prescriber compliance in the emergency department and on wards.

Cited by 12 publications

References 28 publications

Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review

Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review

In-Hospital Macro-, Meso-, and Micro-Drivers and Interventions for Antibiotic Use and Resistance: A Rapid Evidence Synthesis of Data from Canada and Other OECD Countries

Towards a Medicine of the Whole Person – knowledge, practice and holism in the care of the sick

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