多方面干预措施对养老院居民疑似尿路感染抗菌药物处方数量的影响：整群随机对照试验
Effect of a multifaceted intervention on number of antimicrobial prescriptions for suspected urinary tract infections in residents of nursing homes: cluster randomised controlled trial.
作者信息
Loeb Mark, Brazil Kevin, Lohfeld Lynne, McGeer Allison, Simor Andrew, Stevenson Kurt, Zoutman Dick, Smith Stephanie, Liu Xiwu, Walter Stephen D
机构信息
Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.
出版信息
BMJ. 2005 Sep 24;331(7518):669. doi: 10.1136/bmj.38602.586343.55. Epub 2005 Sep 8.
OBJECTIVE
To assess whether a multifaceted intervention can reduce the number of prescriptions for antimicrobials for suspected urinary tract infections in residents of nursing homes.
DESIGN
Cluster randomised controlled trial.
SETTING
24 nursing homes in Ontario, Canada, and Idaho, United States.
PARTICIPANTS
12 nursing homes allocated to a multifaceted intervention and 12 allocated to usual care. Outcomes were measured in 4217 residents.
INTERVENTIONS
Diagnostic and treatment algorithm for urinary tract infections implemented at the nursing home level using a multifaceted approach--small group interactive sessions for nurses, videotapes, written material, outreach visits, and one on one interviews with physicians.
MAIN OUTCOME MEASURES
Number of antimicrobials prescribed for suspected urinary tract infections, total use of antimicrobials, admissions to hospital, and deaths.
RESULTS
Fewer courses of antimicrobials for suspected urinary tract infections per 1000 resident days were prescribed in the intervention nursing homes than in the usual care homes (1.17 v 1.59 courses; weighted mean difference -0.49, 95% confidence intervals -0.93 to -0.06). Antimicrobials for suspected urinary tract infection represented 28.4% of all courses of drugs prescribed in the intervention nursing homes compared with 38.6% prescribed in the usual care homes (weighted mean difference -9.6%, -16.9% to -2.4%). The difference in total antimicrobial use per 1000 resident days between intervention and usual care groups was not significantly different (3.52 v 3.93; weighted mean difference -0.37, -1.17 to 0.44). No significant difference was found in admissions to hospital or mortality between the study arms.
CONCLUSION
A multifaceted intervention using algorithms can reduce the number of antimicrobial prescriptions for suspected urinary tract infections in residents of nursing homes.
目的
评估多方面干预措施能否减少疗养院居民疑似尿路感染的抗菌药物处方数量。
设计
整群随机对照试验。
地点
加拿大安大略省和美国爱达荷州的24家疗养院。
参与者
12家疗养院被分配接受多方面干预，12家被分配接受常规护理。对4217名居民进行了结果测量。
干预措施
在疗养院层面采用多方面方法实施尿路感染的诊断和治疗算法——为护士举办小组互动会议、播放录像带、提供书面材料、进行外展访问以及与医生进行一对一访谈。
主要结局指标
疑似尿路感染的抗菌药物处方数量、抗菌药物的总使用量、住院人数和死亡人数。
结果
干预组疗养院每1000居民日开具的疑似尿路感染抗菌药物疗程数少于常规护理组（1.17对1.59个疗程；加权平均差-0.49，95%置信区间-0.93至-0.06）。干预组疗养院中，疑似尿路感染的抗菌药物占所有开具药物疗程的28.4%，而常规护理组为38.6%（加权平均差-9.6%，-16.9%至-2.4%）。干预组和常规护理组每1000居民日抗菌药物总使用量的差异无统计学意义（3.52对3.93；加权平均差-0.37，-1.17至0.44）。研究组之间在住院人数或死亡率方面未发现显著差异。
结论
使用算法的多方面干预措施可减少疗养院居民疑似尿路感染的抗菌药物处方数量。
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