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Antibiotic Prescribing Patterns for Respiratory Tract Illnesses Following the Conclusion of an Education and Feedback Intervention in Primary Care.
Harrigan, James J; Hamilton, Keith W; Cressman, Leigh; Bilker, Warren B; Degnan, Kathleen O; David, Michael Z; Tran, David; Pegues, David A; Dutcher, Lauren.
Afiliación
  • Harrigan JJ; Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
  • Hamilton KW; Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
  • Cressman L; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
  • Bilker WB; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
  • Degnan KO; Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
  • David MZ; Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
  • Tran D; Independent Researcher.
  • Pegues DA; Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
  • Dutcher L; Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Clin Infect Dis ; 78(5): 1120-1127, 2024 May 15.
Article en En | MEDLINE | ID: mdl-38271275
ABSTRACT

BACKGROUND:

A study previously conducted in primary care practices found that implementation of an educational session and peer comparison feedback was associated with reduced antibiotic prescribing for respiratory tract diagnoses (RTDs). Here, we assess the long-term effects of this intervention on antibiotic prescribing following cessation of feedback.

METHODS:

RTD encounters were grouped into tiers based on antibiotic prescribing appropriateness tier 1, almost always indicated; tier 2, possibly indicated; and tier 3, rarely indicated. A χ2 test was used to compare prescribing between 3 time periods pre-intervention, intervention, and post-intervention (14 months following cessation of feedback). A mixed-effects multivariable logistic regression analysis was performed to assess the association between period and prescribing.

RESULTS:

We analyzed 260 900 RTD encounters from 29 practices. Antibiotic prescribing was more frequent in the post-intervention period than in the intervention period (28.9% vs 23.0%, P < .001) but remained lower than the 35.2% pre-intervention rate (P < .001). In multivariable analysis, the odds of prescribing were higher in the post-intervention period than the intervention period for tier 2 (odds ratio [OR], 1.19; 95% confidence interval [CI] 1.10-1.30; P < .05) and tier 3 (OR, 1.20; 95% CI 1.12-1.30) indications but was lower compared to the pre-intervention period for each tier (OR, 0.66; 95% CI 0.59-0.73 tier 2; OR, 0.68; 95% CI 0.61-0.75 tier 3).

CONCLUSIONS:

The intervention effects appeared to last beyond the intervention period. However, without ongoing provider feedback, there was a trend toward increased prescribing. Future studies are needed to determine optimal strategies to sustain intervention effects.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Atención Primaria de Salud / Infecciones del Sistema Respiratorio / Pautas de la Práctica en Medicina / Antibacterianos Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Clin Infect Dis Asunto de la revista: DOENCAS TRANSMISSIVEIS Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Atención Primaria de Salud / Infecciones del Sistema Respiratorio / Pautas de la Práctica en Medicina / Antibacterianos Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Clin Infect Dis Asunto de la revista: DOENCAS TRANSMISSIVEIS Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos