Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel.
BMJ Open. 2021 Jan 13;11(1):e039810. doi: 10.1136/bmjopen-2020-039810.
Antimicrobial resistance undermines our ability to treat bacterial infections, leading to longer hospital stays, increased morbidity and mortality, and a mounting burden to the healthcare system. Antimicrobial stewardship is increasingly important to safeguard the efficacy of existing drugs, as few new drugs are in the developmental pipeline. While significant progress has been made with respect to stewardship in hospitals, relatively little progress has been made in the primary care setting, where the majority of antimicrobials are prescribed. OPEN Stewardship is an international collaboration to develop an automated feedback platform to improve responsible antimicrobial prescribing among primary care physicians and capable of being deployed across heterogeneous healthcare settings. We describe the protocol for an evaluation of this automated feedback intervention with two main objectives: assessing changes in antimicrobial prescribing among participating physicians and determining the usability and usefulness of the reports.
A non-randomised evaluation of the automated feedback intervention (OPEN Stewardship) will be conducted among approximately 150 primary care physicians recruited from Ontario, Canada and Southern Israel, based on a series of targeted stewardship messages sent using the platform. Using a controlled interrupted time-series analysis and multilevel negative binomial modelling, we will compare the antimicrobial prescribing rates of participants before and after the intervention, and also to the prescribing rates of non-participants (from the same healthcare network) during the same period. We will examine outcomes targeted by the stewardship messages, including prescribing for antimicrobials with duration longer than 7 days and prescribing for indications where antimicrobials are typically unnecessary. Participants will also complete a series of surveys to determine the usability and usefulness of the stewardship reports.
All sites have obtained ethics committee approval to recruit providers and access anonymised prescribing data. Dissemination will occur through open-access publication, stakeholder networks and national/international meetings.
抗菌药物耐药性削弱了我们治疗细菌感染的能力，导致住院时间延长、发病率和死亡率增加，给医疗保健系统带来越来越大的负担。抗菌药物管理对于保护现有药物的疗效变得越来越重要，因为很少有新的药物处于研发管道中。尽管在医院管理方面取得了重大进展，但在初级保健环境中相对进展较小，而大多数抗菌药物都在初级保健环境中开具。OPEN 管理是一项国际合作，旨在开发一个自动化反馈平台，以改善初级保健医生负责任的抗菌药物处方，并能够在异构医疗保健环境中部署。我们描述了对该自动化反馈干预措施进行评估的方案，该方案有两个主要目标：评估参与医生的抗菌药物处方变化情况，以及确定报告的可用性和有用性。
将对来自加拿大安大略省和以色列南部的约 150 名初级保健医生进行非随机评价，这是基于使用该平台发送的一系列有针对性的管理信息。使用控制中断时间序列分析和多水平负二项式模型，我们将比较干预前后参与者的抗菌药物处方率，以及同一时期非参与者（来自同一医疗保健网络）的处方率。我们将检查管理信息所针对的结果，包括处方持续时间超过 7 天的抗菌药物的处方和处方通常不必要的情况下的抗菌药物处方。参与者还将完成一系列调查，以确定管理报告的可用性和有用性。
所有站点都已获得伦理委员会批准，以招募提供者并访问匿名处方数据。传播将通过开放获取出版物、利益相关者网络和国家/国际会议进行。
