Leppien Emily E, Demler Tammie Lee, Trigoboff Eileen
Dr. Leppien is with the Binghamton University School of Pharmacy and Pharmaceutical Sciences and Lourdes Hospital Center for Pain and Wellness in Binghamton, New York.
Drs. Demler and Trigoboff are with the Buffalo Psychiatric Center, New York State Office of Mental Health, the University at Buffalo School of Pharmacy and Pharmaceutical Sciences (Department of Pharmacy Practice) and the University at Buffalo School of Medicine (Department of Psychiatry) in Buffalo, New York.
Innov Clin Neurosci. 2019 May 1;16(5-6):22-29.
Antimicrobial resistance threatens the effective prevention and treatment of many types of infections. Infection occurs more frequently in patients diagnosed with psychiatric illness due to a number of risk factors. Urinary tract infections (UTI) are among the most common infections in this patient population. Currently, there is little information available offering guidance on how to treat infections commonly reported in patients with psychiatric illnesses, nor are there specific recommendations on how to provide efficient and effective educational interventions to prescribers who typically are not infectious disease specialists yet are responsible for treating infections within a psychiatric hospital. This study aims to determine 1) whether psychiatric inpatients were appropriately treated for a urinary tract infection (UTI) prior to educational interventions, and 2) whether there is a relationship between different modes of educational interventions and increased knowledge attainment and retention among healthcare clinicians regarding UTI treatment. This study also sought to determine if 3) health-team teaching used as an enablement method improves antibiotic prescribing and if 4) the number of appropriate UTI treatment regimens increased following educational intervention compared to baseline (prior to educational intervention). A 10-question pre-test survey focusing on UTIs was administered to clinicians in various healthcare disciplines who were later randomly assigned to receive UTI educational interventions either as a live lecture or independent study with identical content. The same 10-question survey was administered as a post-test, 6 to 7 weeks following the educational intervention. Antibiotic prescribing prior to and following educational interventions was assessed to note prescribing trends. Analysis showed that healthcare providers who received live education scored higher on the post-test survey versus those who received directions for self-directed review of educational material presented at the live educational intervention (<0.001). Following educational interventions, the number of urine samples collected for suspected UTI decreased, resulting in a decrease of unnecessary antibiotic treatment. The number of appropriately prescribed antibiotic treatment regimens increased following educational efforts. These enablement educational intervention strategies resulted in significantly improved antibiotic prescribing, indicating that andragogical teaching methods, reinforced through printed material and verbal communication of prescribing deficits, promotes knowledge retention and improved care for patients hospitalized with psychiatric illness.
抗菌药物耐药性威胁着多种感染的有效预防和治疗。由于多种风险因素，感染在被诊断患有精神疾病的患者中更为频繁地发生。尿路感染（UTI）是该患者群体中最常见的感染之一。目前，几乎没有信息可指导如何治疗精神疾病患者中常见的感染，对于如何向通常不是传染病专家但负责在精神病医院治疗感染的开处方者提供高效且有效的教育干预措施，也没有具体建议。本研究旨在确定：1）在进行教育干预之前，精神病住院患者的尿路感染（UTI）是否得到了适当治疗；2）不同教育干预模式与医疗保健临床医生对UTI治疗的知识获取和保留增加之间是否存在关联。本研究还试图确定：3）用作赋能方法的团队健康教育是否能改善抗生素处方；4）与基线（教育干预前）相比，教育干预后适当的UTI治疗方案数量是否增加。对不同医疗保健学科的临床医生进行了一项关于UTI的10道题预测试调查，随后他们被随机分配接受UTI教育干预，干预方式为现场讲座或内容相同的自主学习。在教育干预6至7周后，进行相同的10道题调查作为后测试。评估教育干预前后的抗生素处方情况以记录处方趋势。分析表明，接受现场教育的医疗保健提供者在后测试调查中的得分高于那些收到关于在现场教育干预中展示的教育材料进行自主复习指导的提供者（<0.001）。教育干预后，因疑似UTI而采集的尿液样本数量减少，从而减少了不必要的抗生素治疗。教育努力后，适当开具的抗生素治疗方案数量增加。这些赋能教育干预策略显著改善了抗生素处方，表明通过印刷材料和关于处方缺陷的口头交流强化的成人教学方法，促进了知识保留并改善了对患有精神疾病住院患者的护理。
