Reduction of Inappropriate Antibiotic Use and Improved Outcomes by Implementation of an Algorithm-Based Clinical Guideline for Nonpurulent Skin and Soft Tissue Infections

Haran, John P.; Goulding, Melissa; Campion, Maureen; Scully, Gail; Chandra, Arnav; Goldberg, Rebecca; Day, Allyson; McLendon, Emily; Clark, Melissa A.

doi:10.1016/j.annemergmed.2019.12.012

Cited by 5 publications

(3 citation statements)

References 37 publications

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“…Clinical decision support and nudge have complementary features94 95 which can be leveraged in resource-limited settings where electronic clinical decision support might not be an option and nudge might suffice. Feedback worked best when it was immediate,178 specific,73 detailed,179 case-based,180 181 individualised with peer group comparison159 182 and accompanied by deep engagement with clinicians 136. Engagement of multidisciplinary stakeholders in development of priorities, identification of barriers and design of interventions led to effective deimplementation 81 183 184.…”

Section: Discussionmentioning

confidence: 99%

What works for and what hinders deimplementation of low-value care in emergency medicine practice? A scoping review

Gangathimmaiah,

Drever,

Evans

et al. 2023

BMJ Open

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ObjectivesLow-value care can harm patients and healthcare systems. Despite a decade of global endeavours, low value care has persisted. Identification of barriers and enablers is essential for effective deimplementation of low-value care. This scoping review is an evidence summary of barriers, enablers and features of effective interventions for deimplementation of low-value care in emergency medicine practice worldwide.DesignA mixed-methods scoping review was conducted using the Arksey and O’Malley framework.Data sourcesMedline, CINAHL, Embase, EMCare, Scopus and grey literature were searched from inception to 5 December 2022.Eligibility criteriaPrimary studies which employed qualitative, quantitative or mixed-methods approaches to explore deimplementation of low-value care in an EM setting and reported barriers, enablers or interventions were included. Reviews, protocols, perspectives, comments, opinions, editorials, letters to editors, news articles, books, chapters, policies, guidelines and animal studies were excluded. No language limits were applied.Data extraction and synthesisStudy selection, data collection and quality assessment were performed by two independent reviewers. Barriers, enablers and interventions were mapped to the domains of the Theoretical Domains Framework. The Mixed Methods Appraisal Tool was used for quality assessment.ResultsThe search yielded 167 studies. A majority were quantitative studies (90%, 150/167) that evaluated interventions (86%, 143/167). Limited provider abilities, diagnostic uncertainty, lack of provider insight, time constraints, fear of litigation, and patient expectations were the key barriers. Enablers included leadership commitment, provider engagement, provider training, performance feedback to providers and shared decision-making with patients. Interventions included one or more of the following facets: education, stakeholder engagement, audit and feedback, clinical decision support, nudge, clinical champions and training. Multifaceted interventions were more likely to be effective than single-faceted interventions. Effectiveness of multifaceted interventions was influenced by fidelity of the intervention facets. Use of behavioural change theories such as the Theoretical Domains Framework in the published studies appeared to enhance the effectiveness of interventions to deimplement low-value care.ConclusionHigh-fidelity, multifaceted interventions that incorporated education, stakeholder engagement, audit/feedback and clinical decision support, were administered daily and lasted longer than 1 year were most effective in achieving deimplementation of low-value care in emergency departments. This review contributes the best available evidence to date, but further rigorous, theory-informed, qualitative and mixed-methods studies are needed to supplement the growing body of evidence to effectively deimplement low-value care in emergency medicine practice.

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Section: Discussionmentioning

confidence: 99%

What works for and what hinders deimplementation of low-value care in emergency medicine practice? A scoping review

Gangathimmaiah,

Drever,

Evans

et al. 2023

BMJ Open

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“…En la esfera mundial se clasifican las IPTB de modo heterogéneo, acorde a criterios para su análisis como lo es según la severidad (5,10,21), que podría explicar lo encontrado en el presente estudio. En lo referente a la localización señalada, esta es similar a lo indicado por diversidad de reportes en el mundo (20,22,(26)(27)(28). En esta investigación en una IPS de Palmira, hubo diferencias en la adecuada o no prescripción antibiótica por tipo y ubicación de la infección; pero que son descartadas en el análisis ajustado.…”

Section: Discussionunclassified

“…De este modo, se considera relevante conocer los factores relacionados con el fenómeno de la no adecuación de las prescripciones antibióticas en otras regiones de Colombia. Esto permitiría sustentar probables intervenciones de mejora a nivel local e inclusive ejecutar futuros estudios prospectivos aplicando guía nacional como ya ha comenzado a realizarse recientemente en el mundo (22,23). Así, este estudio tiene como objetivo relacionar los factores de las IPTB no purulentas en pacientes adultos ambulatorios con prescripciones antibióticas no adecuadas en una institución prestadora de servicios de salud (IPS) de Palmira en 2019.…”

Section: Introductionunclassified

Factores relacionados con la prescripción inadecuada de antibioticoterapia en adultos con infecciones de piel en consulta ambulatoria

Risueño Blanco

2023

biosalud

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Introducción: Las infecciones de piel y tejidos blandos (IPTB) son frecuente motivo de consulta ambulatoria. El estudio de los factores relacionados con no adecuación antibiótica en IPTB constituye el punto inicial para enfrentar a la resistencia bacteriana. Objetivo: Relacionar los factores de las IPTB no purulentas en pacientes adultos ambulatorios con prescripción inadecuada de antibioticoterapia en una IPS de Palmira en el año 2019. Métodos: Estudio transversal analítico retrospectivo. Se usó muestreo aleatorio simple. Se recolectó información de historias clínicas. El tratamiento antibiótico se consideró adecuado si fue acorde a guías. Se realizó estadística descriptiva de todas las variables, posteriormente se realizaron comparaciones de grupos según sí la terapia antibiótica fue adecuada o no; finalmente, se realizó análisis multivariado para control de confusión. Resultados: Para una muestra de 213 historias clínicas el antibiótico más prescrito fue cefalexina (37,1 %); se encuentra una automedicación antibiótica (13,1 %) y 76,1 % de las prescripciones fueron adecuadas. En el análisis multivariante, la automedicación antibiótica (OR 17,523, IC 95 % 1,127-272,5) y la vía intramuscular (OR 44,358, IC 95 % 1,161-1695,461) se relacionaron con prescripción antibiótica no adecuada. Conclusión: Se recomienda la implementación de guías locales en servicios médicos ambulatorios con afianzamiento en sus directrices y la educación a comunidad respecto a la automedicación antibiótica desde la atención primaria para disminuir la no adecuación de la terapia antibiótica.

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A multifaceted intervention improves antibiotic stewardship for skin and soft tissues infections

May

Nguyen

Trajano

et al. 2021

The American Journal of Emergency Medicine

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Reduction of Inappropriate Antibiotic Use and Improved Outcomes by Implementation of an Algorithm-Based Clinical Guideline for Nonpurulent Skin and Soft Tissue Infections

Cited by 5 publications

References 37 publications

What works for and what hinders deimplementation of low-value care in emergency medicine practice? A scoping review

What works for and what hinders deimplementation of low-value care in emergency medicine practice? A scoping review

Factores relacionados con la prescripción inadecuada de antibioticoterapia en adultos con infecciones de piel en consulta ambulatoria

A multifaceted intervention improves antibiotic stewardship for skin and soft tissues infections

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