What are the similarities and differences in antimicrobial prescribing between Australian public and private hospitals?

Abstract

Background: Identifying themes associated with inappropriate prescribing in

Balancing the risks to individual and society: a systematic review and synthesis of qualitative research on antibiotic prescribing behaviour in hospitals

“…The current review demonstrated important sector-specific pressures and incentives that shape prescribing decision-making, related to prescriber autonomy, patient demand and competition between private healthcare facilities, which could strongly drive up antibiotic prescribing rates. Further research into changing prescriber behaviour in the specific context of private healthcare provision would be of value [73].…”

Influences on surgical antimicrobial prophylaxis decision making by surgical craft groups, anaesthetists, pharmacists and nurses in public and private hospitals

“…This study examines clinicians’ perceptions across public and private hospitals as research demonstrates a difference in SAP guideline compliance between the two settings [14]. Public hospitals generally deal with more complicated and acute cases, while private hospitals have higher rates of elective and day procedures [14, 15]. This difference may contribute to observed variations in SAP practices.…”

Audit‐based measures of overuse of medical care in Australian hospital practice

“…For studies of management strategies (Table ), corresponding rates of overuse comprised: 14–74% of blood product infusions among patients with various conditions ( n = 3) 15–55% of older patients receiving at least one inappropriate medication ( n = 7) 34% of chronically prescribed medications of various classes among older patients ( n = 1) 99% of ondansetron prescriptions in patients with severe emesis ( n = 1) 63–90% of regular prescriptions for gastric acid suppressants in patients admitted to intensive care units ( n = 2) 34% of regular prescriptions of direct oral anticoagulants in patients with various conditions ( n = 1) 21% of antimicrobial prescriptions for patients with acute infections ( n = 1) 52% of prescriptions for inhaled corticosteroids in patients with mild chronic obstructive pulmonary disease ( n = 1) 55% of instances of high flow oxygen therapy administered to patients with chronic obstructive pulmonary disease ( n = 1) 33% of overnight admissions to medical assessment and planning unit for monitoring and evaluation relating to patients presenting to emergency department with undifferentiated chest pain and low coronary risk ( n = 1) 10–64% of end‐of‐life care admissions featuring the administration of futile interventions ( n = 3) …”

“…• 14-74% of blood product infusions among patients with various conditions (n = 3) [21][22][23] • 15-55% of older patients receiving at least one inappropriate medication (n = 7) [24][25][26][27][28][29][30] • 34% of chronically prescribed medications of various classes among older patients (n = 1) 31 • 99% of ondansetron prescriptions in patients with severe emesis (n = 1) 32 • 63-90% of regular prescriptions for gastric acid suppressants in patients admitted to intensive care units (n = 2) 33,34 • 34% of regular prescriptions of direct oral anticoagulants in patients with various conditions (n = 1) 35 • 21% of antimicrobial prescriptions for patients with acute infections (n = 1) 36 • 52% of prescriptions for inhaled corticosteroids in patients with mild chronic obstructive pulmonary disease (n = 1) 37 • 55% of instances of high flow oxygen therapy administered to patients with chronic obstructive pulmonary disease (n = 1) 38 • 33% of overnight admissions to medical assessment and planning unit for monitoring and evaluation relating to patients presenting to emergency department with undifferentiated chest pain and low coronary risk (n = 1) 39 • 10-64% of end-of-life care admissions featuring the administration of futile interventions (n = 3) [40][41][42] Of the eight studies reporting post-audit use of QI strategies, 7,[9][10][11]15,19,21,22 professional education strategies, guideline or pathway dissemination, and implementation of algorithms and other forms of decision support were the dominant strategies used. Of the five studies reporting results of post-QI follow-up audits, 7,9,11,15,19 all relating to use of investigations, absolute reductions in rate of overuse ...…”