Reliability of assessment of adherence to an antimicrobial treatment guideline

Mol, Peter G. M.; Gans, Rijk O. B.; Panday, Prashant V Nannan; Degener, John E.; Laseur, M.; Haaijer‐Ruskamp, Flora

doi:10.1016/j.jhin.2004.11.022

Cited by 15 publications

(10 citation statements)

References 28 publications

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“…Likewise, Hanlon and colleagues found almost perfect agreement (kappa score Z 0.83) between a clinical pharmacist and internist-geriatrician when assessing appropriateness of chronic medications taken by ten ambulatory, elderly male patients [19]. Our results, however, are more consistent with a previous study on inter-rater reliability among antimicrobial prescriptions conducted in 2005 [20]. In that investigation, Mol and colleagues found fair to moderate agreement among six remote assessors (two hospital pharmacists, two internists and two clinical microbiologists) who were asked to assess adherence of antimicrobial prescriptions to local hospital guidelines.…”

Section: Discussionsupporting

confidence: 88%

Evaluating antimicrobial therapy: How reliable are remote assessors?

Cotta

Spelman

Chen

et al. 2016

Infection, Disease & Health

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Section: Discussionsupporting

confidence: 88%

Evaluating antimicrobial therapy: How reliable are remote assessors?

Cotta

Spelman

Chen

et al. 2016

Infection, Disease & Health

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“…However, the appropriateness rate depends on the criteria used, which may vary across studies. 21 For example, the treatment durations recommended in our local guidelines are at the lower end of the range found in national and international recommendations for many infections. Increasing the recommended duration would have increased the appropriateness rate at treatment completion.…”

Section: Discussionmentioning

confidence: 94%

“…However, all antibiotic prescriptions were reviewed independently by 2 infectious diseases specialists. 21 A second limitation is that only about half the physicians both completed the case vignettes and prescribed antibiotics, and only about half the antibiotic prescriptions were written by physicians who had completed the case vignettes. Nevertheless, we found a significant association between the case vignette scores and the appropriateness of antibiotic prescriptions.…”

Section: Discussionmentioning

confidence: 99%

Do Case Vignettes Accurately Reflect Antibiotic Prescription?

Lucet

Nicolas–Chanoine

Lefort

et al. 2011

Infect. Control Hosp. Epidemiol.

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“…Within this criterion we also considered whether the study assessed the reliability of outcome measurement. This is especially important when considering the appropriateness of antibiotic use as it requires clinical judgement, and previous studies have shown that this can vary between assessors 36–38. Studies without controls (interrupted time series or before-after designs) were rated against three additional criteria.…”

Section: Methodsmentioning

confidence: 99%

Effectiveness of interventions targeting antibiotic use in long-term aged care facilities: a systematic review and meta-analysis

Raban

Gasparini

et al. 2020

BMJ Open

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ObjectivesThere are high levels of inappropriate antibiotic use in long-term care facilities (LTCFs). Our objective was to examine evidence of the effectiveness of interventions designed to reduce antibiotic use and/or inappropriate use in LTCFs.DesignSystematic review and meta-analysis.Data sourcesMEDLINE, Embase and CINAHL from 1997 until November 2018.Eligibility criteriaControlled and uncontrolled studies in LTCFs measuring intervention effects on rates of overall antibiotic use and/or appropriateness of use were included. Secondary outcomes were intervention implementation barriers from process evaluations.Data extraction and synthesisTwo reviewers independently applied the Cochrane Effective Practice and Organisation of Care group’s resources to classify interventions and assess risk of bias. Meta-analyses used random effects models to pool results.ResultsOf include studies (n=19), 10 had a control group and 17 had a high risk of bias. All interventions had multiple components. Eight studies (with high risk of bias) showed positive impacts on outcomes and included one of the following interventions: audit and feedback, introduction of care pathways or an infectious disease team. Meta-analyses on change in the percentage of residents on antibiotics (pooled relative risk (RR) (three studies, 6862 residents): 0.85, 95% CI: 0.61 to 1.18), appropriateness of decision to treat with antibiotics (pooled RR (three studies, 993 antibiotic orders): 1.10, 95% CI: 0.64 to 1.91) and appropriateness of antibiotic selection for respiratory tract infections (pooled RR (three studies, 292 orders): 1.15, 95% CI: 0.95 to 1.40), showed no significant intervention effects. However, meta-analyses only included results from intervention groups since most studies lacked a control group. Insufficient data prevented meta-analysis on other outcomes. Process evaluations (n=7) noted poor intervention adoption, low physician engagement and high staff turnover as barriers.ConclusionsThere is insufficient evidence that interventions employed to date are effective at improving antibiotic use in LTCFs. Future studies should use rigorous study designs and tailor intervention implementation to the setting.

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Reliability of assessment of adherence to an antimicrobial treatment guideline

Cited by 15 publications

References 28 publications

Evaluating antimicrobial therapy: How reliable are remote assessors?

Evaluating antimicrobial therapy: How reliable are remote assessors?

Do Case Vignettes Accurately Reflect Antibiotic Prescription?

Effectiveness of interventions targeting antibiotic use in long-term aged care facilities: a systematic review and meta-analysis

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