Metlay Joshua P, Camargo Carlos A, MacKenzie Thomas, McCulloch Charles, Maselli Judith, Levin Sara K, Kersey Ayanna, Gonzales Ralph
Center for Health Equity Research and Promotion, VA Medical Center, Philadelphia, PA, USA.
Ann Emerg Med. 2007 Sep;50(3):221-30. doi: 10.1016/j.annemergmed.2007.03.022. Epub 2007 May 23.
We evaluate the effectiveness of an educational program in hospital emergency departments (EDs) targeting reduction in antibiotic overuse for acute respiratory tract infections.
Sixteen hospitals participated in the cluster randomized trial, selecting a Veterans Administration (VA) and non-VA hospital within each of 8 metropolitan regions. Intervention sites received performance feedback, clinician education, and patient educational materials, including an interactive computer kiosk located in the waiting room. Medical records were reviewed at each site during the baseline year 1 and intervention year 2. The primary measure of effect was the percentage of visits for upper respiratory tract infections and acute bronchitis that were treated with antibiotics. Secondary outcomes, including return visits and visit satisfaction, were assessed by follow-up telephone interviews of patients. Alternating logistic regression models were used to adjust for baseline treatment rates, case mix differences, and provider characteristics.
The adjusted antibiotic prescription level for upper respiratory tract infection/acute bronchitis visits was 47% for control sites and 52% for intervention sites in year 1. Antibiotic prescriptions at control sites increased by 0.5% between year 1 and year 2 (95% confidence interval -3% to 5%) and at intervention sites decreased by 10% (95% confidence interval -18% to -2%). There were no significant differences between control and intervention sites in the proportions of upper respiratory tract infection/bronchitis patients with return ED visits or in overall visit satisfaction.
Multidimensional educational interventions can reduce antibiotic overuse in the treatment of patients with upper respiratory tract infections and acute bronchitis in EDs. However, substantial antibiotic overuse persists despite this educational intervention.
我们评估了一项针对医院急诊科的教育项目的有效性，该项目旨在减少急性呼吸道感染中抗生素的过度使用。
16家医院参与了这项整群随机试验，在8个大都市地区各选择一家退伍军人管理局（VA）医院和一家非VA医院。干预地点接受了绩效反馈、临床医生教育和患者教育材料，包括位于候诊室的交互式电脑信息亭。在第1年基线期和第2年干预期对每个地点的病历进行了审查。主要疗效指标是上呼吸道感染和急性支气管炎就诊中接受抗生素治疗的比例。次要结局，包括复诊和就诊满意度，通过对患者的随访电话访谈进行评估。使用交替逻辑回归模型来调整基线治疗率、病例组合差异和提供者特征。
第1年，对照地点上呼吸道感染/急性支气管炎就诊的调整后抗生素处方水平为47%，干预地点为52%。对照地点的抗生素处方在第1年至第2年之间增加了0.5%（95%置信区间为-3%至5%），而干预地点则下降了10%（95%置信区间为-18%至-2%）。在复诊的上呼吸道感染/支气管炎患者比例或总体就诊满意度方面，对照地点和干预地点之间没有显著差异。
多维度教育干预可以减少急诊科上呼吸道感染和急性支气管炎患者治疗中抗生素的过度使用。然而，尽管有这种教育干预，抗生素的大量过度使用仍然存在。
