Boise Veterans' Affairs (VA) Medical Center, Boise, Idaho.
College of Pharmacy, Idaho State University, Meridian, Idaho.
Infect Control Hosp Epidemiol. 2023 May;44(5):746-754. doi: 10.1017/ice.2022.182. Epub 2022 Aug 15.
To determine whether a clinician-directed acute respiratory tract infection (ARI) intervention was associated with improved antibiotic prescribing and patient outcomes across a large US healthcare system.
Multicenter retrospective quasi-experimental analysis of outpatient visits with a diagnosis of uncomplicated ARI over a 7-year period.
Outpatients with ARI diagnoses: sinusitis, pharyngitis, bronchitis, and unspecified upper respiratory tract infection (URI-NOS). Outpatients with concurrent infection or select comorbid conditions were excluded.
INTERVENTION(S): Audit and feedback with peer comparison of antibiotic prescribing rates and academic detailing of clinicians with frequent ARI visits. Antimicrobial stewards and academic detailing personnel delivered the intervention; facility and clinician participation were voluntary.
MEASURE(S): We calculated the probability to receive antibiotics for an ARI before and after implementation. Secondary outcomes included probability for a return clinic visits or infection-related hospitalization, before and after implementation. Intervention effects were assessed with logistic generalized estimating equation models. Facility participation was tracked, and results were stratified by quartile of facility intervention intensity.
We reviewed 1,003,509 and 323,023 uncomplicated ARI visits before and after the implementation of the intervention, respectively. The probability to receive antibiotics for ARI decreased after implementation (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.78-0.86). Facilities with the highest quartile of intervention intensity demonstrated larger reductions in antibiotic prescribing (OR, 0.69; 95% CI, 0.59-0.80) compared to nonparticipating facilities (OR, 0.89; 95% CI, 0.73-1.09). Return visits (OR, 1.00; 95% CI, 0.94-1.07) and infection-related hospitalizations (OR, 1.21; 95% CI, 0.92-1.59) were not different before and after implementation within facilities that performed intensive implementation.
Implementation of a nationwide ARI management intervention (ie, audit and feedback with academic detailing) was associated with improved ARI management in an intervention intensity-dependent manner. No impact on ARI-related clinical outcomes was observed.
确定临床医生主导的急性呼吸道感染（ARI）干预是否与改善美国大型医疗保健系统内的抗生素处方和患者结局相关。
对 7 年内门诊就诊的单纯性 ARI 患者进行多中心回顾性准实验分析。
ARI 诊断患者：鼻窦炎、咽炎、支气管炎和未特指的上呼吸道感染（URI-NOS）。排除同时存在感染或某些特定合并症的患者。
对抗生素处方率进行审核和反馈，并对经常就诊的医生进行同行比较和学术讲解。抗菌药物管理专家和学术讲解人员提供干预措施；医疗机构和医生参与是自愿的。
我们计算了实施前后接受 ARI 抗生素治疗的概率。次要结局包括实施前后的复诊率或感染相关住院率。使用逻辑广义估计方程模型评估干预效果。跟踪医疗机构的参与情况，并根据医疗机构干预强度的四分位间距对结果进行分层。
我们分别回顾了实施干预措施前后的 1,003,509 例和 323,023 例单纯性 ARI 就诊。实施后接受 ARI 抗生素治疗的概率降低（优势比[OR]，0.82；95%置信区间[CI]，0.78-0.86）。干预强度最高四分位数的医疗机构与未参与医疗机构相比（OR，0.69；95% CI，0.59-0.80），抗生素处方减少幅度更大（OR，0.89；95% CI，0.73-1.09）。在实施干预措施后，医疗机构内复诊（OR，1.00；95% CI，0.94-1.07）和感染相关住院（OR，1.21；95% CI，0.92-1.59）的比例无差异。
在全国范围内实施 ARI 管理干预措施（即审核和反馈加上学术讲解）与以干预强度为依赖的方式改善 ARI 管理相关。但未观察到对 ARI 相关临床结局有影响。
