减少儿童非严重性结膜炎的眼部抗生素使用。
Reducing Ophthalmic Antibiotic Use for Non-severe Conjunctivitis in Children.
机构信息
Department of Pediatrics, Denver Health and Hospital Authority, Denver, Colorado, USA.
Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.
出版信息
J Pediatric Infect Dis Soc. 2023 Sep 27;12(9):496-503. doi: 10.1093/jpids/piad065.
BACKGROUND
Antibiotics are often overprescribed for pediatric conjunctivitis. We implemented a system-level quality improvement (QI) intervention to reduce unnecessary ophthalmic antibiotic use.
METHODS
The multi-faceted intervention in Denver, CO comprised a clinical care pathway, nurse protocol modifications, electronic health record (EHR) changes, parent education materials, and clinician education. We evaluated children aged 6 months-17 years with conjunctivitis seen between November 2018 and December 2022. A multi-interrupted time series model evaluated the effectiveness of the intervention over three time periods: Pre-COVID, Pre-Intervention (November 2018-February 2020), COVID, Pre-Intervention (March 2020-March 2021), and Post-Intervention (April 2021-December 2022). Fisher's exact tests compared treatment failure and healthcare utilization rates between time periods and among children receiving or not receiving ophthalmic antibiotics.
RESULTS
Among 6960 eligible encounters, ophthalmic antibiotic use was reduced by 18.8% (95% CI: 16.3, 21.3) from Pre-COVID, Pre-Intervention to Post-Intervention. During the Pre-Intervention period following the onset of COVID, a reduction of 16.1% (95% CI: 12.9, 19.3) was observed. Implementation of the intervention resulted in an additional 2.7% (95% CI: -0.4, 5.7) reduction in antibiotic prescribing, primarily in younger children (ages 6 months-5 years). The greatest reduction in prescribing occurred for nurse triage encounters with an 82.1% (95% CI: 76.8, 87.5) reduction in prescribing rates (92.6%-10.5%). Treatment failure occurred in 1301 (18.7%) children and was more common among children that received an ophthalmic antibiotic than those that did not (20.0 vs 17.9%; P = .03).
CONCLUSION
The QI intervention significantly reduced ophthalmic antibiotic prescribing for pediatric conjunctivitis without increasing treatment failure rates or health care utilization.
背景
抗生素常被过度用于治疗小儿结膜炎。我们实施了一项系统层面的质量改进（QI）干预措施，以减少不必要的眼科抗生素使用。
方法
在科罗拉多州丹佛市，这项多方面的干预措施包括临床护理路径、护士方案修改、电子健康记录（EHR）更改、家长教育材料和临床医生教育。我们评估了 2018 年 11 月至 2022 年 12 月期间就诊的 6 个月至 17 岁患有结膜炎的儿童。一个多中断时间序列模型评估了该干预措施在三个时间段内的有效性：COVID 前、干预前（2018 年 11 月至 2020 年 2 月）、COVID 期间、干预前（2020 年 3 月至 2021 年 3 月）和干预后（2021 年 4 月至 2022 年 12 月）。Fisher 确切检验比较了不同时间段之间以及接受或未接受眼科抗生素治疗的儿童之间的治疗失败和医疗保健利用率。
结果
在 6960 例符合条件的就诊中，从 COVID 前、干预前到干预后，眼科抗生素的使用率降低了 18.8%（95%CI：16.3，21.3）。在 COVID 开始后的干预前期间，观察到抗生素使用率降低了 16.1%（95%CI：12.9，19.3）。实施干预措施后，抗生素处方减少了 2.7%（95%CI：-0.4，5.7），主要是在年龄较小的儿童（6 个月至 5 岁）中。处方率下降最大的是护士分诊就诊，处方率下降了 82.1%（95%CI：76.8，87.5）（92.6%-10.5%）。1301 名（18.7%）儿童发生治疗失败，接受眼科抗生素治疗的儿童比未接受治疗的儿童更常见（20.0%比 17.9%；P=0.03）。
结论
QI 干预措施显著减少了小儿结膜炎的眼科抗生素处方，而不会增加治疗失败率或增加医疗保健利用率。
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