Roberts Elaine, Dawoud Dalia M, Hughes Dyfrig A, Cefai Christopher
Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wrexham, UK.
Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK.
Int J Pharm Pract. 2015 Oct;23(5):333-9. doi: 10.1111/ijpp.12173. Epub 2015 Jan 28.
This study aims to evaluate the effectiveness and acceptability of a pharmacist-led antimicrobial stewardship intervention, consisting of consultant performance audit and feedback, on antimicrobial prescribing quality.
From October 2010 to September 2012, the prescribing performance of medical consultant teams rotating on the acute medical admissions unit was measured against four quality indicators. Measurements were taken at baseline then at quarterly intervals during which time consultants received feedback. Proportion of prescriptions adhering to each indicator was compared with baseline using paired sample z-test (significance level P < 0.01, Bonferroni corrected). Consultants' views were explored using anonymous questionnaires.
Overall, 2609 antimicrobial prescriptions were reviewed. Improvement from baseline was statistically significant in all follow-up periods for two indicators: 'antimicrobials should have a documented indication in the medical notes' and 'antimicrobials should adhere to guideline choice or have a justification for deviation', reaching 6.0% (95% CI 2.5, 9.6) and 8.7% (95% CI 3.7, 13.7), respectively. Adherence to the indicator 'antimicrobials should have a documented stop/review prompt' improved significantly in all but the first follow-up period. For the indicator: 'antimicrobial assessed by antimicrobial specialists as unnecessary', improvement was statistically significant in the first (-4.7%, 95% CI -8.0, -1.4) and fourth (-4.2%, 95% CI -7.7%, -0.8%) periods. Service evaluation showed support for the pharmacist-led stewardship activities.
There were significant and sustained improvements in prescribing quality as a result of the intervention. Consultants' engagement and acceptance of stewardship activities were demonstrated.
本研究旨在评估由药剂师主导的抗菌药物管理干预措施（包括会诊绩效审核与反馈）对抗菌药物处方质量的有效性和可接受性。
2010年10月至2012年9月期间，针对急性内科住院病房轮转的医疗会诊团队的处方行为，依据四项质量指标进行衡量。在基线期进行测量，随后每季度测量一次，在此期间会诊医生会收到反馈。使用配对样本z检验（显著性水平P < 0.01，经Bonferroni校正）将符合各指标的处方比例与基线期进行比较。通过匿名问卷探究会诊医生的看法。
总体而言，共审查了2609份抗菌药物处方。在所有随访期内，两项指标从基线期开始均有统计学显著改善：“抗菌药物在病历中应有记录的适应证”以及“抗菌药物应符合指南选择或有偏离的合理理由”，分别达到6.0%（95%可信区间2.5，9.6）和8.7%（95%可信区间3.7，13.7）。除第一个随访期外，在所有随访期内，“抗菌药物应有记录的停用/复查提示”指标的依从性均显著提高。对于“抗菌药物专家评估为不必要的抗菌药物”这一指标，在第一个（-4.7%，95%可信区间-8.0，-1.4）和第四个（-4.2%，95%可信区间-7.7%，-0.8%）时期有统计学显著改善。服务评估显示对抗菌药物管理活动得到了支持。
干预措施使处方质量得到了显著且持续的改善。证明了会诊医生对抗菌药物管理活动的参与和接受。
