基于初级保健抗生素处方审核的反馈访视和临床决策支持系统的效果：多组整群随机对照试验

Effect of a Feedback Visit and a Clinical Decision Support System Based on Antibiotic Prescription Audit in Primary Care: Multiarm Cluster-Randomized Controlled Trial.

作者信息

Jeanmougin Pauline, Larramendy Stéphanie, Fournier Jean-Pascal, Gaultier Aurélie, Rat Cédric

机构信息

Department of General Practice, Faculty of Medicine, Nantes University, Nantes, France.

Antibioclic Steering Committee, Paris, France.

出版信息

J Med Internet Res. 2024 Dec 18;26:e60535. doi: 10.2196/60535.

DOI:10.2196/60535

PMID:39693139

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11694052/

Abstract

BACKGROUND

While numerous antimicrobial stewardship programs aim to decrease inappropriate antibiotic prescriptions, evidence of their positive impact is needed to optimize future interventions.

OBJECTIVE

This study aimed to evaluate 2 multifaceted antibiotic stewardship interventions for inappropriate systemic antibiotic prescription in primary care.

METHODS

An open-label, cluster-randomized controlled trial of 2501 general practitioners (GPs) working in western France was conducted from July 2019 to January 2021. Two interventions were studied: the standard intervention, consisting of a visit by a health insurance representative who gave prescription feedback and provided a leaflet for treating cystitis and tonsillitis; and a clinical decision support system (CDSS)-based intervention, consisting of a visit with prescription feedback and a CDSS demonstration on antibiotic prescribing. The control group received no intervention. Data on systemic antibiotic dispensing was obtained from the National Health Insurance System (Système National d'Information Inter-Régimes de l'Assurance Maladie) database. The overall antibiotic volume dispensed per GP at 12 months was compared between arms using a 2-level hierarchical analysis of covariance adjusted for annual antibiotic prescription volume at baseline.

RESULTS

Overall, 2501 GPs were randomized (n=1099, 43.9% women). At 12 months, the mean volume of systemic antibiotics per GP decreased by 219.2 (SD 61.4; 95% CI -339.5 to -98.8; P<.001) defined daily doses in the CDSS-based visit group compared with the control group. The decrease in the mean volume of systemic antibiotics dispensed per GP was not significantly different between the standard visit group and the control group (-109.7, SD 62.4; 95% CI -232.0 to 12.5 defined daily doses; P=.08).

CONCLUSIONS

A visit by a health insurance representative combining feedback and a CDSS demonstration resulted in a 4.4% (-219.2/4930) reduction in the total volume of systemic antibiotic prescriptions in 12 months.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04028830; https://clinicaltrials.gov/study/NCT04028830.

摘要

背景

虽然众多抗菌药物管理计划旨在减少不恰当的抗生素处方，但需要其积极影响的证据来优化未来的干预措施。

目的

本研究旨在评估针对基层医疗中不恰当的全身性抗生素处方的两种多方面抗菌药物管理干预措施。

方法

2019年7月至2021年1月，在法国西部工作的2501名全科医生（GP）中开展了一项开放标签、整群随机对照试验。研究了两种干预措施：标准干预，包括由健康保险代表进行一次访视，该代表提供处方反馈并提供一份治疗膀胱炎和扁桃体炎的传单；以及基于临床决策支持系统（CDSS）的干预，包括一次有处方反馈的访视以及一次关于抗生素处方的CDSS演示。对照组未接受任何干预。全身性抗生素配药数据来自国家健康保险系统（Système National d'Information Inter-Régimes de l'Assurance Maladie）数据库。使用针对基线年度抗生素处方量进行调整的两级分层协方差分析，比较了两组中每位全科医生在12个月时全身性抗生素的总体配药量。

结果

总体而言，2501名全科医生被随机分组（n = 1099，43.9%为女性）。在12个月时，与对照组相比，基于CDSS访视组中每位全科医生全身性抗生素的平均剂量减少了219.2（标准差61.4；95%置信区间 -339.5至 -98.8；P <.001）限定日剂量。标准访视组与对照组相比，每位全科医生全身性抗生素配药平均剂量的减少无显著差异（-109.7，标准差62.4；95%置信区间 -232.0至12.5限定日剂量；P = 0.08）。