Division of Infectious Disease, Department of Pediatrics, Kobe Children's Hospital, 7-6-1, Minami-machi, Minatojima, Tyuo-ku, Kobe, Hyogo, 650-0047, Japan.
Department of Pharmacy, Kobe Children's Primary Emergency Medical Center, 1-4-1, Wakinohama-Kaigandori, Tyuo-ku, Kobe, Hyogo, 651-0073, Japan.
Eur J Pediatr. 2021 Jun;180(6):1933-1940. doi: 10.1007/s00431-021-03979-3. Epub 2021 Feb 8.
Outpatient medical facilities tend to have high antimicrobial prescription rates and are therefore major targets for antimicrobial stewardship programs (ASPs). Pediatric primary emergency medical centers in Japan have difficulties in implementing conventional ASPs due to the low continuity of stewardship. Accordingly, there is a need to develop effective ASP models for these facilities. We conducted a single-center, quasi-experimental study to evaluate the effects of a nudge-based ASP in reducing unnecessary third-generation cephalosporin (3GC) prescriptions in a pediatric primary emergency care center (PEC). The implemented ASP utilizes monthly newsletters that report current antimicrobial use patterns and prescribing targets. We compared the monthly 3GC prescription numbers and proportions of unnecessary prescriptions before and after the ASP was implemented. The trends in 3GC prescriptions were examined using an interrupted time-series analysis. The numbers of patients before and after ASP implementation were 129,156 and 28,834, respectively. The number of unnecessary 3GC prescriptions decreased by 67.2% in the year after ASP implementation. The interrupted time-series analysis showed that the ASP was significantly associated with a reduction in 3GC prescriptions (regression coefficient - 0.58, P < 0.001).Conclusion: The nudge-based ASP was effective in reducing 3GC use in a Japanese PEC. This simple and inexpensive approach may have applications in other outpatient facilities. What is Known: • Outpatient medical facilities tend to have high antimicrobial prescription rates. Despite the development of several strategies for outpatient antimicrobial stewardship programs, these approaches have not sufficiently reduced antimicrobial use. What is New • Our nudge-based antimicrobial stewardship program using newsletters was shown to be a simple, inexpensive, and feasible method for reducing unnecessary antimicrobial use in a pediatric primary emergency care center. This may represent an effective antimicrobial stewardship strategy in Japanese outpatient facilities.
门诊医疗机构往往具有较高的抗菌药物处方率，因此是抗菌药物管理计划（ASPs）的主要目标。由于管理的连续性较低，日本儿科初级急诊医疗中心在实施常规 ASP 方面存在困难。因此，需要为这些医疗机构开发有效的 ASP 模型。我们进行了一项单中心、准实验研究，以评估基于提示的 ASP 在减少儿科初级急诊护理中心（PEC）中不必要的第三代头孢菌素（3GC）处方方面的效果。实施的 ASP 利用每月的通讯，报告当前的抗菌药物使用模式和处方目标。我们比较了 ASP 实施前后每月 3GC 处方数量和不必要处方的比例。使用中断时间序列分析检查 3GC 处方的趋势。ASP 实施前后的患者人数分别为 129156 人和 28834 人。ASP 实施后的一年内，不必要的 3GC 处方数量减少了 67.2%。中断时间序列分析表明，ASP 与 3GC 处方减少显著相关（回归系数 -0.58，P < 0.001）。结论：基于提示的 ASP 可有效减少日本 PEC 中 3GC 的使用。这种简单且廉价的方法可能适用于其他门诊医疗机构。已知：• 门诊医疗机构往往具有较高的抗菌药物处方率。尽管已经开发了几种针对门诊抗菌药物管理计划的策略，但这些方法并没有充分减少抗菌药物的使用。新发现：• 我们使用通讯的基于提示的抗菌药物管理计划被证明是一种简单、廉价且可行的方法，可以减少儿科初级急诊护理中心不必要的抗菌药物使用。这可能代表日本门诊医疗机构中有效的抗菌药物管理策略。
