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Zhao B, Wu J. Impact of China's National Volume-Based Procurement on Drug Procurement Price, Volume, and Expenditure: An Interrupted Time Series Analysis in Tianjin. Int J Health Policy Manag 2023; 12:7724. [PMID: 38618801 PMCID: PMC10590231 DOI: 10.34172/ijhpm.2023.7724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 08/26/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND National Volume-Based Procurement (NVBP) program has been carried out in China to lower drug prices and reduce patients' medication burden. This study aims to evaluate its impact on drug purchasing in Tianjin city, one of the first 11 cities piloting NVBP in China. METHODS Using monthly drug procurement data from Tianjin Medical Purchasing Center between 2018 and 2020, this study identified bid-winning drugs and their alternative drugs in the pilot NVBP, and evaluated the policy impacts on their procurement price (cost of defined daily dose, DDDc), volume (the number of defined daily dose, DDDs), and expenditure, during the first (initiated at April 1, 2019) and second (initiated at April 25, 2020) procurement cycles of pilot NVBP, applying interrupted time series (ITS) analysis. Included drugs were classified into 12 pharmacological subgroups for further analysis. RESULTS Decrease in DDDc of NVBP-covered drugs (bid-winning and non-winning drugs) were observed in the first (level change: -CNY 3.878/DDD, P<.001; trend change: -CNY 0.068/DDD, P=.001; relative change: -61.55%) and second (level change: -CNY 0.356/DDD, P=.049) procurement cycles of pilot NVBP, while no significant change was observed for the DDDc of alternative drugs, except for the increase in antidiarrheic and anti-inflammatory/antirheumatic subgroups as more expensive drugs were purchased from new suppliers in the second procurement cycle. The DDDs of bid-winning drugs significantly increased, while decreased for the non-winning original and generic drugs. Procurement expenditure was saved for NVBP-covered drugs (level change: -CNY 7.29×107, P<.001; trend change: -CNY 5.62×106, P<.001; relative change: -62.60%). However, during the second procurement cycle, procurement volume and expenditure of alternative drugs increased significantly in 7 out of 12 subgroups. CONCLUSION The pilot NVBP policy in China reduced procurement price, promoted generic substitution, and saved procurement expenditure. However, the increase in procurement price, volume and expenditure of alternative drugs may reveal the significance of regulating healthcare institutions' drug purchasing behavior.
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Affiliation(s)
- Boya Zhao
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China
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Nayebi A, Tipirneni S, Reddy CK, Foreman B, Subbian V. WindowSHAP: An efficient framework for explaining time-series classifiers based on Shapley values. J Biomed Inform 2023; 144:104438. [PMID: 37414368 PMCID: PMC10552726 DOI: 10.1016/j.jbi.2023.104438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 06/29/2023] [Accepted: 07/03/2023] [Indexed: 07/08/2023]
Abstract
Unpacking and comprehending how black-box machine learning algorithms (such as deep learning models) make decisions has been a persistent challenge for researchers and end-users. Explaining time-series predictive models is useful for clinical applications with high stakes to understand the behavior of prediction models, e.g., to determine how different variables and time points influence the clinical outcome. However, existing approaches to explain such models are frequently unique to architectures and data where the features do not have a time-varying component. In this paper, we introduce WindowSHAP, a model-agnostic framework for explaining time-series classifiers using Shapley values. We intend for WindowSHAP to mitigate the computational complexity of calculating Shapley values for long time-series data as well as improve the quality of explanations. WindowSHAP is based on partitioning a sequence into time windows. Under this framework, we present three distinct algorithms of Stationary, Sliding and Dynamic WindowSHAP, each evaluated against baseline approaches, KernelSHAP and TimeSHAP, using perturbation and sequence analyses metrics. We applied our framework to clinical time-series data from both a specialized clinical domain (Traumatic Brain Injury - TBI) as well as a broad clinical domain (critical care medicine). The experimental results demonstrate that, based on the two quantitative metrics, our framework is superior at explaining clinical time-series classifiers, while also reducing the complexity of computations. We show that for time-series data with 120 time steps (hours), merging 10 adjacent time points can reduce the CPU time of WindowSHAP by 80 % compared to KernelSHAP. We also show that our Dynamic WindowSHAP algorithm focuses more on the most important time steps and provides more understandable explanations. As a result, WindowSHAP not only accelerates the calculation of Shapley values for time-series data, but also delivers more understandable explanations with higher quality.
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Affiliation(s)
- Amin Nayebi
- Department of Systems and Industrial Engineering, University of Arizona, AZ, USA.
| | | | | | | | - Vignesh Subbian
- Department of Systems and Industrial Engineering, University of Arizona, AZ, USA; Department of Biomedical Engineering, University of Arizona, AZ, USA
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eHealthResp, a Digital Intervention to Improve Antibiotic Prescribing in Respiratory Infections: A Pilot Study. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081160. [PMID: 36013339 PMCID: PMC9410258 DOI: 10.3390/life12081160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 11/17/2022]
Abstract
The emergence of antibiotic resistance (ABR) is one of the most serious public health threats worldwide. The inappropriate use of antibiotics is considered the main determinant for the increase and development of ABR, contributing to a greater risk of therapeutic ineffectiveness, particularly within primary care context. Therefore, this pilot study aims to raise awareness and promote an adequate antibiotic use among physicians, through the evaluation of the eHealthResp platform, a digital intervention composed by an online course and a mobile application, to aid in the management of respiratory tract infections. The global validation of the eHealthResp platform was carried out by 12 physicians who explored and performed a quantitative and qualitative evaluation of the contents of the online course and mobile app. The global evaluation of the analyzed parameters was very positive, with the highest median scores being attributed to adequacy, correction, format, and trust of the eHealthResp platform. The qualitative feedback enhanced the contents’ relevance, clarity, and consolidation, as well as the effectiveness of the educational intervention against ABR. Overall, this study revealed that the eHealthResp may be regarded as an important e-health tool for the management of respiratory tract infections and improvement of antibiotic prescription practices among physicians.
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Impact of the COVID-19 Pandemic on Antibiotic Prescribing by Dentists in Galicia, Spain: A Quasi-Experimental Approach. Antibiotics (Basel) 2022; 11:antibiotics11081018. [PMID: 36009887 PMCID: PMC9404831 DOI: 10.3390/antibiotics11081018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 07/19/2022] [Accepted: 07/27/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Antibiotic resistance is one of the most pressing public health problems. Health authorities, patients, and health professionals, including dentists, are all involved in its development. COVID-19 pandemic restrictions on dental care may have had repercussions on antibiotic prescribing by dentists. The aim of this study was to assess the impact of the COVID-19 pandemic on antibiotic prescribing by dentists, and to review antibiotic consumption according to the WHO Access, Watch, Reserve classification. We conducted a natural, before-and-after, quasi-experimental study, using antibiotic prescription data covering the period from January 2017 to May 2021. A segmented regression analysis with interrupted time series data was used to analyse the differences between the numbers of defined daily doses (DDD) of antibiotics prescribed monthly. The outcomes showed an immediate significant decrease in overall antibiotic prescribing by primary-care dentists during lockdown, followed by a non-significant upward trend for the next year. This same pattern was, likewise, observed for Access and Watch antibiotics. COVID-19 pandemic restrictions on dental care influenced the prescription of antibiotics. During confinement, an initial decrease was observed, this trend changed when in person consultations were recovered. It might be beneficial to analyse the prescription of antibiotics using the WHO AWaRe classification, in order to monitor their appropriate use.
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Arshad H, Gillani AH, Akbar J, Abbas H, Bashir Ahmed A, Gillani SNH, Anum R, Ji W, Fang Y. Knowledge on Multi-Drug Resistant Pathogens, Antibiotic Use and Self-Reported Adherence to Antibiotic Intake: A Population-Based Cross Sectional Survey From Pakistan. Front Pharmacol 2022; 13:903503. [PMID: 35712718 PMCID: PMC9194673 DOI: 10.3389/fphar.2022.903503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: Surveying public awareness of antibiotic use and antibiotics can identify factors relevant to the design of effective educational campaigns. The aim of this study was to evaluate the knowledge, attitudes, and practices related to antibiotic use and multidrug-resistant pathogens in the general population in Pakistan. Research Design and Methods: Cross-sectional survey was conducted, using a 60 itemed structured questionnaire and recruited individuals by convenient sampling from the general population in the four provinces of the country. Descriptive statistics were used to evaluate the responses and the chi squared statistic was used to assess differences between groups. Results: The response rate was 87.6% (6,684 out of 7,631 individuals). Half of the respondents had received at least one prescription of antibiotics in the 6 months preceding the survey. Knowledge about antibiotic use, (39.8%) individuals scored above the mean (≥3) showed good knowledge about antibiotic use. Urban residents and male showed significant higher knowledge (p < 0.001) about antibiotic use. Approximately 50% of the respondents correctly answered the question about antibiotic resistance. Of the 3,611 received antibiotics, 855 (23.7%) were indicated for cough, 497 (13.8%) for a sore throat, 335 (9.3%) for ear ache, 665 (18.4%) for a burning sensation during urination, 667 (18.4%) for wounds or soft tissue inflammation. MDR pathogen was perceived as an important topic by (4,010) 60.1% of respondents. Conclusion: Participants were aware of the problem of multidrug-resistant pathogens and understood the responsibility of each individual to avoid the spread of these infectious agents.
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Affiliation(s)
- Hafsa Arshad
- Department of Pharmacy Management and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Drug Safety and Policy Research Center, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Centre for Health Reform and Development Research, Xi'an Jiaotong University, Xi'an, China.,Department of Pharmacy, Faculty of Biological Sciences, Quaid-I-Azam University, Islamabad, Pakistan
| | - Ali Hassan Gillani
- Department of Pharmacy Management and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Drug Safety and Policy Research Center, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Centre for Health Reform and Development Research, Xi'an Jiaotong University, Xi'an, China
| | - Jamshaid Akbar
- Department of Pharmaceutical Sciences, School of Pharmacy, The Superior University, Lahore, Pakistan
| | - Huda Abbas
- Department of Community Medicine Quaid-e-Azam Medical College, Bahawalpur, Pakistan
| | | | | | | | - Wenjing Ji
- Department of Pharmacy Management and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Drug Safety and Policy Research Center, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Centre for Health Reform and Development Research, Xi'an Jiaotong University, Xi'an, China
| | - Yu Fang
- Department of Pharmacy Management and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Drug Safety and Policy Research Center, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Centre for Health Reform and Development Research, Xi'an Jiaotong University, Xi'an, China
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Estrela M, Silva TM, Gomes ER, Piñeiro M, Figueiras A, Roque F, Herdeiro MT. Prescription of anxiolytics, sedatives, hypnotics and antidepressants in outpatient, universal care during the COVID-19 pandemic in Portugal: a nationwide, interrupted time-series approach. J Epidemiol Community Health 2022; 76:335-340. [PMID: 34625519 PMCID: PMC8507401 DOI: 10.1136/jech-2021-216732] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 09/25/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND The COVID-19 pandemic has had a significant impact on the population's mental health. However, its impact on the consumption of anxiolytics, sedatives, hypnotics and antidepressants remains to be evaluated. Hence, this article aims to assess the prescription trends of these drugs in Portugal, from January 2018 to March 2021, while critically examining whether the COVID-19 pandemic had an impact on these prescription trends or not. METHODS A nationwide interrupted time-series analysis of the prescription data of anxiolytics, sedatives, hypnotics and antidepressants in outpatient setting of the public health sector was conducted. The data encompassed the defined daily dose per month, age range and sex and were analysed following a segmented regression approach. RESULTS The pandemic preceded an immediate reduction in the prescription of anxiolytics, sedatives and hypnotics for children and adolescents. However, an increasing trend throughout the pandemic has been noted in the prescription of these drugs, especially among adults aged 65 years or above. A drop in antidepressant prescription was observed as an immediate effect of the pandemic among male and female adolescents and elderly women. From March 2020 to March 2021, a decreasing prescription trend has been noted among men. CONCLUSIONS When analysing specific genders and age ranges, differences can be noted, in terms of both immediate impact and prescribing trends throughout 1 year of the COVID-19 pandemic. The impact of the pandemic on mental health and its association with the consumption trends of psychoactive drugs, and with the access to mental health treatments, should be further assessed.
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Affiliation(s)
- Marta Estrela
- iBiMED - Institute of Biomedicine - Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Tânia Magalhães Silva
- iBiMED - Institute of Biomedicine - Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Eva Rebelo Gomes
- Allergy and Clinical Immunology Service, University Hospital Center of Porto, Porto, Portugal
| | - Maria Piñeiro
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), University of Santiago de Compostela, Santiago de Compostela, Spain
- Institute of Health Research of Santiago de Compostela, Santiago de Compostela, Spain
| | - Adolfo Figueiras
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), University of Santiago de Compostela, Santiago de Compostela, Spain
- Institute of Health Research of Santiago de Compostela, Santiago de Compostela, Spain
| | - Fátima Roque
- Research Unit for Inland Development, Guarda Polytechnic Institute, Guarda, Portugal
- Health Sciences Research Centre, University of Beira Interior, Covilhã, Castelo Branco, Portugal
| | - Maria Teresa Herdeiro
- iBiMED - Institute of Biomedicine - Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
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Lambert M, Smit CCH, De Vos S, Benko R, Llor C, Paget WJ, Briant K, Pont L, Van Dijk L, Taxis K. A systematic literature review and meta-analysis of community pharmacist-led interventions to optimise the use of antibiotics. Br J Clin Pharmacol 2022; 88:2617-2641. [PMID: 35112381 PMCID: PMC9313811 DOI: 10.1111/bcp.15254] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 01/11/2022] [Accepted: 01/24/2022] [Indexed: 12/01/2022] Open
Abstract
Aims The aim of this systematic review is to assess the effects of community pharmacist‐led interventions to optimise the use of antibiotics and identify which interventions are most effective. Methods This review was conducted according to the PRISMA guidelines (PROSPERO: CRD42020188552). PubMed, EMBASE and the Cochrane Central Register of Controlled Trials were searched for (randomised) controlled trials. Included interventions were required to target antibiotic use, be set in the community pharmacy context, and be pharmacist‐led. Primary outcomes were quality of antibiotic supply and adverse effects while secondary outcomes included patient‐reported outcomes. Risk of bias was assessed using the ‘Cochrane suggested risk of bias criteria’ and narrative synthesis of primary outcomes conducted. Results Seventeen studies were included covering in total 3822 patients (mean age 45.6 years, 61.9% female). Most studies used educational interventions. Three studies reported on primary outcomes, 12 on secondary outcomes and two on both. Three studies reported improvements in quality of dispensing, interventions led to more intensive symptom assessment (up to 30% more advice given) and a reduction of over‐the‐counter supply up to 53%. Three studies led to higher consumer satisfaction, effects on adherence from nine studies were mixed (risk difference 0.04 [−0.02, 0.10]). All studies had unclear or high risks of bias across at least one domain, with large heterogeneity between studies. Conclusions Our review suggests some positive results from pharmacist‐led interventions, but the interventions do not seem sufficiently effective as currently implemented. This review should be interpreted as exploratory research, as more high‐quality research is needed.
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Affiliation(s)
- Maarten Lambert
- Faculty of Science and Engineering, Department of PharmacoTherapy, - Epidemiology and -Economics, University of Groningen, Groningen, The Netherlands
| | - Chloé C H Smit
- University of Technology Sydney, Graduate School of Health, NSW, Sydney, Australia
| | - Stijn De Vos
- Faculty of Science and Engineering, Department of PharmacoTherapy, - Epidemiology and -Economics, University of Groningen, Groningen, The Netherlands
| | - Ria Benko
- Department of Clinical Pharmacy and Albert Szent-Györgyi Medical Center, Central Pharmacy and Emergency Care Department, University of Szeged, Szeged, Hungary
| | - Carl Llor
- University Institute in Primary Care Research Jordi Gol, Via Roma Health Centre, Barcelona, Barcelona, Spain.,University of Southern Denmark, Public Health, General Practice, Odense C, Denmark
| | - W John Paget
- Nivel, Netherlands institute for health services research, CR, Utrecht, The Netherlands
| | - Kathryn Briant
- Health Care Consumers' Association, Hackett, ACT, Australia
| | - Lisa Pont
- University of Technology Sydney, Graduate School of Health, NSW, Sydney, Australia
| | - Liset Van Dijk
- Faculty of Science and Engineering, Department of PharmacoTherapy, - Epidemiology and -Economics, University of Groningen, Groningen, The Netherlands.,Nivel, Netherlands institute for health services research, CR, Utrecht, The Netherlands
| | - Katja Taxis
- Faculty of Science and Engineering, Department of PharmacoTherapy, - Epidemiology and -Economics, University of Groningen, Groningen, The Netherlands
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Shirazi OU, Ab Rahman NS, Zin CS. An overview of the hospitals’ antimicrobial stewardship programs implemented to improve antibiotics’ utilization, cost and resistance patterns. JOURNAL OF PHARMACY 2022. [DOI: 10.31436/jop.v2i1.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Introduction: The high reliance of the physicians and surgeons on the antibiotics since their discovery has led to an irrational antibiotic utilization which not only has raised the incidence of antimicrobial resistance (AMR) but also increased the cost of treatment with antibiotics as high use of antibiotics has been found related to the occurrence of certain nosocomial infections which need extra antibiotic courses to be cured. In order to overcome these antibiotic utilization related problems an antimicrobial stewardship (AMS) program being the set of various persuasive, restrictive and structural interventions is considered an effective tool to rationalize the in-patient antimicrobial utilization worldwide.
Method: The focus of this review is on the interventions that are being implemented during the in-patient AMS programs and have been described effective in controlling the antibiotic utilization, their cost of treatment and an overall infection control. The literature containing the information about various AMS interventions effecting the utilization and cost patterns along with the impact on AMR was searched in various databases such as PubMed, Google Scholar, Science Direct, Ovid (Medline) and Scopus. The categorical sorting of the published data is based on various AMS interventions such as the guideline development, formulary restriction (pre-authorization), educative interventions, clinical pathway development and prospective (post prescription) audit. Considering the objectives of the study such as the goal to curb overutilization of antibiotics, control of their cost of treatment for in-patients and infection control the sorted literature is presented in three different tables describing the AMS impact on the said outcomes.
Results: The post AMS changes in utilization patterns are described as fall of antibiotics defined daily doses (DDD) and days of therapy (DOT) which resulted in the reduction of the cost of treatment with antibiotics. The reduction of the cost of treatment with antibiotics also resulted due to the AMS impact on the control of various nosocomial and multi-drug resistant (MDR) infections.
Conclusion: It has been concluded that the AMS program if implemented under the supervision of an expert AMS team mainly comprising of an infectious disease (ID) physician, clinical pharmacists and microbiologists with considerable support by the hospital authorities could be a highly efficient tool of the pharmacovigilance for rationalizing the in-patient antimicrobial practice.
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Curtis HJ, Bacon S, Croker R, Walker AJ, Perera R, Hallsworth M, Harper H, Mahtani KR, Heneghan C, Goldacre B. Evaluating the impact of a very low-cost intervention to increase practices' engagement with data and change prescribing behaviour: a randomized trial in English primary care. Fam Pract 2021; 38:373-380. [PMID: 33783497 DOI: 10.1093/fampra/cmaa128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Unsolicited feedback can solicit changes in prescribing. OBJECTIVES Determine whether a low-cost intervention increases clinicians' engagement with data, and changes prescribing; with or without behavioural science techniques. METHODS Randomized trial (ISRCTN86418238). The highest prescribing practices in England for broad-spectrum antibiotics were allocated to: feedback with behavioural impact optimization; plain feedback; or no intervention. Feedback was sent monthly for 3 months by letter, fax and email. Each included a link to a prescribing dashboard. The primary outcomes were dashboard usage and change in prescribing. RESULTS A total of 1401 practices were randomized: 356 behavioural optimization, 347 plain feedback, and 698 control. For the primary engagement outcome, more intervention practices had their dashboards viewed compared with controls [65.7% versus 55.9%; RD 9.8%, 95% confidence intervals (CIs): 4.76% to 14.9%, P < 0.001]. More plain feedback practices had their dashboard viewed than behavioural feedback practices (69.1% versus 62.4%); but not meeting the P < 0.05 threshold (6.8%, 95% CI: -0.19% to 13.8%, P = 0.069). For the primary prescribing outcome, intervention practices possibly reduced broad-spectrum prescribing to a greater extent than controls (1.42% versus 1.12%); but again not meeting the P < 0.05 threshold (coefficient -0.31%, CI: -0.7% to 0.1%, P = 0.104). The behavioural impact group reduced broad-spectrum prescribing to a greater extent than plain feedback practices (1.63% versus 1.20%; coefficient 0.41%, CI: 0.007% to 0.8%, P = 0.046). No harms were detected. CONCLUSIONS Unsolicited feedback increased practices' engagement with data, with possible slightly reduced antibiotic prescribing (P = 0.104). Behavioural science techniques gave greater prescribing effects. The modest effects on prescribing may reflect saturation from similar initiatives on antibiotic prescribing. CLINICAL TRIAL REGISTRATION ISRCTN86418238.
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Affiliation(s)
- Helen J Curtis
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Seb Bacon
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Richard Croker
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Alex J Walker
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rafael Perera
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | | | - Kamal R Mahtani
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Carl Heneghan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ben Goldacre
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Navarro Cárdenas JD, Alarcón Nieto MC, Bernal Vargas MP, Estrada-Orozco K, Gaitán Duarte H. Effectiveness, safety and implementation results of the strategies aimed at the safe prescription of medications in university hospitals in adult patients. Systematic review. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2021. [DOI: 10.5554/22562087.e997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: A broad range of practices aimed at improving the effectives and safety of this process have been documented over the past few years.
Objective: to establish the effectiveness, safety and results of the implementation of these strategies in adult patients in university hospitals.
Methodology: A review of systematic reviews was conducted, in addition to a database search in the Cochrane Library of Systematic Reviews, Embase, Epistemonikos, LILACS and gray literature. Any strategy aimed at reducing prescription-associated risks was included as intervention. This review followed the protocol registered in the International Prospective Registry of Systematic Reviews (PROSPERO): CRD42020165143.
Results: 7,637 studies were identified, upon deleting duplicate references. After excluding records based on titles and abstracts, 111 full texts were assessed for eligibility. Fifteen studies were included in the review. Several interventions grouped into 5 strategies addressed to the prescription process were identified; the use of computerized medical order entry systems (CPOE), whether integrated or not with computerized decision support systems (CDSS), was the most effective approach.
Conclusions: The beneficial effects of the interventions intended to the prescription process in terms of efficacy were identified; however, safety and implementation results were not thoroughly assessed. The heterogeneity of the studies and the low quality of the reviews, preclude a meta-analysis.
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Estrela M, Roque F, Silva TM, Zapata-Cachafeiro M, Figueiras A, Herdeiro MT. Validation of the eHealthResp online course for pharmacists and physicians: A Delphi method approach. Biomed Pharmacother 2021; 140:111739. [PMID: 34020245 DOI: 10.1016/j.biopha.2021.111739] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 11/30/2022] Open
Abstract
FRAMEWORK The inappropriate use of antibiotics for respiratory tract infections is dispersed worldwide, thus being a strong contributor to antibiotic resistances. As the use of educational interventions among health practitioners is shown to have an impact on judicious antibiotic use, an online course (eHealthResp) has been developed, especially targeted to pharmacists and physicians. Thus, the main goal of this study is to validate the contents of the online course eHealthResp. METHODS This two-round Delphi study involved the recruitment of a multidisciplinary panel (n = 19), to which the questionnaires of the first round were sent. After the first round, a report summing up the results has been forwarded to the panel, along with a new, reformulated version of the questionnaire. RESULTS After the two rounds of the Delphi process, consensus was evaluated. Six clinical cases and fifty-one treatments obtained minor consensus [60-75%] or full consensus (≥75%). The question on antibiotic practice has obtained a consensus >90% on both rounds. CONCLUSIONS The validation of the contents based on experts' consensus has been an essential approach to improve eHealthResp's online course, as valuable feedback has been provided by the panel on both rounds.
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Affiliation(s)
- Marta Estrela
- iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal.
| | - Fátima Roque
- Research Unit for Inland Development, Guarda Polytechnic Institute (UDI-IPG), Guarda, Portugal; Health Sciences Research Center, University of Beira Interior (CICS-UBI), Covilhã, Portugal
| | - Tânia Magalhães Silva
- iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Maruxa Zapata-Cachafeiro
- Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Spain; Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15702 Santiago de Compostela, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiology and Public Health - CIBERESP), Madrid, Spain
| | - Adolfo Figueiras
- Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Spain; Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15702 Santiago de Compostela, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiology and Public Health - CIBERESP), Madrid, Spain
| | - Maria Teresa Herdeiro
- iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
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Do NTT, Vu HTL, Nguyen CTK, Punpuing S, Khan WA, Gyapong M, Asante KP, Munguambe K, Gómez-Olivé FX, John-Langba J, Tran TK, Sunpuwan M, Sevene E, Nguyen HH, Ho PD, Matin MA, Ahmed S, Karim MM, Cambaco O, Afari-Asiedu S, Boamah-Kaali E, Abdulai MA, Williams J, Asiamah S, Amankwah G, Agyekum MP, Wagner F, Ariana P, Sigauque B, Tollman S, van Doorn HR, Sankoh O, Kinsman J, Wertheim HFL. Community-based antibiotic access and use in six low-income and middle-income countries: a mixed-method approach. Lancet Glob Health 2021; 9:e610-e619. [PMID: 33713630 PMCID: PMC8050200 DOI: 10.1016/s2214-109x(21)00024-3] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Antimicrobial misuse is common in low-income and middle-income countries (LMICs), and this practice is a driver of antibiotic resistance. We compared community-based antibiotic access and use practices across communities in LMICs to identify contextually specific targets for interventions to improve antibiotic use practices. METHODS We did quantitative and qualitative assessments of antibiotic access and use in six LMICs across Africa (Mozambique, Ghana, and South Africa) and Asia (Bangladesh, Vietnam, and Thailand) over a 2·5-year study period (July 1, 2016-Dec 31, 2018). We did quantitative assessments of community antibiotic access and use through supplier mapping, customer exit interviews, and household surveys. These quantitative assessments were triangulated with qualitative drug supplier and consumer interviews and discussions. FINDINGS Vietnam and Bangladesh had the largest proportions of non-licensed antibiotic dispensing points. For mild illness, drug stores were the most common point of contact when seeking antibiotics in most countries, except South Africa and Mozambique, where public facilities were most common. Self-medication with antibiotics was found to be widespread in Vietnam (55·2% of antibiotics dispensed without prescription), Bangladesh (45·7%), and Ghana (36·1%), but less so in Mozambique (8·0%), South Africa (1·2%), and Thailand (3·9%). Self-medication was considered to be less time consuming, cheaper, and overall, more convenient than accessing them through health-care facilities. Factors determining where treatment was sought often involved relevant policies, trust in the supplier and the drug, disease severity, and whether the antibiotic was intended for a child. Confusion regarding how to identify oral antibiotics was revealed in both Africa and Asia. INTERPRETATION Contextual complexities and differences between countries with different incomes, policy frameworks, and cultural norms were revealed. These contextual differences render a single strategy inadequate and instead necessitate context-tailored, integrated intervention packages to improve antibiotic use in LMICs as part of global efforts to combat antibiotic resistance. FUNDING Wellcome Trust and Volkswagen Foundation.
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Affiliation(s)
- Nga T T Do
- Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Huong T L Vu
- Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Chuc T K Nguyen
- Department of Family Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Sureeporn Punpuing
- Institute for Population and Social Research, Mahidol University, Nakhonpathom, Thailand
| | - Wasif Ali Khan
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Margaret Gyapong
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | | | - Khatia Munguambe
- Manhiça Health Research Centre, Manhiça, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - F Xavier Gómez-Olivé
- MRC-Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
| | - Johannes John-Langba
- School of Applied Human Sciences, University of Kwazulu-Natal, Durban, South Africa
| | - Toan K Tran
- Department of Family Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Malee Sunpuwan
- Institute for Population and Social Research, Mahidol University, Nakhonpathom, Thailand
| | - Esperanca Sevene
- Manhiça Health Research Centre, Manhiça, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Hanh H Nguyen
- Department of Family Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Phuc D Ho
- Institute of Mathematics, Vietnam Academy of Science and Technology, Hanoi, Vietnam
| | | | - Sabeena Ahmed
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Olga Cambaco
- Manhiça Health Research Centre, Manhiça, Mozambique
| | | | | | | | | | | | | | | | - Fezile Wagner
- MRC-Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
| | - Proochista Ariana
- Nuffied Department of Clinical Medicine, University of Oxford, Oxford, UK
| | | | - Stephen Tollman
- MRC-Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
| | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Hanoi, Vietnam; Nuffied Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Osman Sankoh
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Statistics Sierra Leone, Freetown, Sierra Leone; University Secretariat, Njala University, Njala, Sierra Leone; Heidelberg Institute for Global Health, University of Heidelberg Medical School, Heidelberg, Germany
| | - John Kinsman
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Heiman F L Wertheim
- Oxford University Clinical Research Unit, Hanoi, Vietnam; Department of Medical Microbiology and Radboudumc Center for Infectious Diseases, Radboudumc, Nijmegen, The Netherlands.
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Figueiras A, López-Vázquez P, Gonzalez-Gonzalez C, Vázquez-Lago JM, Piñeiro-Lamas M, López-Durán A, Sánchez C, Herdeiro MT, Zapata-Cachafeiro M. Impact of a multifaceted intervention to improve antibiotic prescribing: a pragmatic cluster-randomised controlled trial. Antimicrob Resist Infect Control 2020; 9:195. [PMID: 33287881 PMCID: PMC7722452 DOI: 10.1186/s13756-020-00857-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 11/18/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES This study sought to assess the effectiveness and return on investment (ROI) of a multifaceted intervention aimed at improving antibiotic prescribing for acute respiratory infections in primary care. DESIGN Large-sized, two-arm, open-label, pragmatic, cluster-randomised controlled trial. SETTING All primary care physicians working for the Spanish National Health Service (NHS) in Galicia (region in north-west Spain). PARTICIPANTS The seven spatial clusters were distributed by unequal randomisation (3:4) of the intervention and control groups. A total of 1217 physicians (1.30 million patients) were recruited from intervention clusters and 1393 physicians (1.46 million patients) from control clusters. INTERVENTIONS One-hour educational outreach visits tailored to training needs identified in a previous study; an online course integrated in practice accreditation; and a clinical decision support system. MAIN OUTCOME MEASURES Changes in the ESAC (European Surveillance of Antimicrobial Consumption) quality indicators for outpatient antibiotic use. We used generalised linear mixed and conducted a ROI analysis to ascertain the overall cost savings. RESULTS Median follow-up was 19 months. The adjusted effect on overall antibiotic prescribing attributable to the intervention was - 4.2% (95% CI: - 5.3% to - 3.2%), with this being more pronounced for penicillins - 6.5 (95% CI: - 7.9% to - 5.2%) and for the ratio of consumption of broad- to narrow-spectrum penicillins, cephalosporins, and macrolides - 9.0% (95% CI: - 14.0 to - 4.1%). The cost of the intervention was €87 per physician. Direct savings per physician attributable to the reduction in antibiotic prescriptions was €311 for the NHS and €573 for patient contributions, with an ROI of €2.57 and €5.59 respectively. CONCLUSIONS Interventions designed on the basis of gaps in physicians' knowledge of and attitudes to misprescription can improve antibiotic prescribing and yield important direct cost savings. TRIAL REGISTRATION Current Controlled Trials ISRCTN24158380 . Registered 5 February 2009.
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Affiliation(s)
- Adolfo Figueiras
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15786, Santiago de Compostela, Spain.
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública- CIBERESP), Santiago de Compostela, Spain.
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
| | - Paula López-Vázquez
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15786, Santiago de Compostela, Spain
| | - Cristian Gonzalez-Gonzalez
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15786, Santiago de Compostela, Spain
| | - Juan Manuel Vázquez-Lago
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15786, Santiago de Compostela, Spain
| | - María Piñeiro-Lamas
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública- CIBERESP), Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Ana López-Durán
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Coro Sánchez
- Pontevedra Primary Care Service, SERGAS Eoxi Pontevedra-Salnés, Pontevedra, Spain
| | - María Teresa Herdeiro
- Department of Medical Sciences & Institute for Biomedicine - iBiMED, University of Aveiro, Aveiro, Portugal
| | - Maruxa Zapata-Cachafeiro
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15786, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública- CIBERESP), Santiago de Compostela, Spain
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Wang X, Tang Y, Liu C, Liu J, Cui Y, Zhang X. Effects of restrictive-prescribing stewardship on antibiotic consumption in primary care in China: an interrupted time series analysis, 2012-2017. Antimicrob Resist Infect Control 2020; 9:159. [PMID: 32977855 PMCID: PMC7519519 DOI: 10.1186/s13756-020-00821-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/21/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The overuse of antibiotics has been a major public health problem worldwide, especially in low- and middle- income countries (LMIC). However, there are few policies specific to antibiotic stewardship in primary care and their effectiveness are still unclear. A restrictive-prescribing stewardship targeting antibiotic use in primary care has been implemented since December 2014 in Hubei Province, China. This study aimed to evaluate the effects of the restrictive-prescribing stewardship on antibiotic consumption in primary care so as to provide evidence-based suggestions for prudent use of antibiotics. METHODS Monthly antibiotic consumption data were extracted from Hubei Medical Procurement Administrative Agency (HMPA) system from Sept 1, 2012, to Aug 31, 2017. Quality Indictors of European Surveillance of Antimicrobial Consumption (ESAC QIs) combined with Anatomical Therapeutic Chemical (ATC) classification codes and DDD per 1000 inhabitants per day (DID) methodology were applied to measure antibiotic consumption. An interrupted time series analysis was performed to evaluate the effects of restrictive-prescribing stewardship on antibiotic consumption. RESULTS Over the entire study period, a significant reduction (32.58% decrease) was observed in total antibiotic consumption, which declined immediately after intervention (coefficient = - 2.4518, P = 0.005) and showed a downward trend (coefficient = - 0.1193, P = 0.017). Specifically, the use of penicillins, cephalosporins and macrolides/lincosamides/streptogramins showed declined trends after intervention (coefficient = - 0.0553, P = 0.035; coefficient = - 0.0294, P = 0.037; coefficient = - 0.0182, P = 0.003, respectively). An immediate decline was also found in the contribution of β-lactamase-sensitive penicillins to total antibiotic use (coefficient = - 2.9126, P = 0.001). However, an immediate increase in the contribution of third and fourth-generation cephalosporins (coefficient = 5.0352, P = 0.005) and an ascending trend in the contribution of fluoroquinolones (coefficient = 0.0406, P = 0.037) were observed after intervention. The stewardship led to an immediate increase in the ratio between broad- and narrow-spectrum antibiotic use (coefficient = 1.8747, P = 0.001) though they both had a significant downward trend (coefficient = - 0.0423, P = 0.017; coefficient = - 0.0223, P = 0.006, respectively). An immediate decline (coefficient = - 1.9292, P = 0.002) and a downward trend (coefficient = - 0.0815, P = 0.018) were also found in the oral antibiotic use after intervention, but no significant changes were observed in the parenteral antibiotic use. CONCLUSIONS Restrictive-prescribing stewardship in primary care was effective in reducing total antibiotic consumption, especially the use of penicillins, cephalosporins and macrolides/lincosamides/streptogramins. However, the intervention effects were limited regarding the use of combinations of penicillins with ß-lactamase inhibitors, the third and fourth-generation cephalosporins, fluoroquinolones and parenteral antibiotics. Stronger administrative regulations focusing on specific targeted antibiotics, especially the use of broad-spectrum antibiotics and parenteral antibiotics, are in urgent need in the future.
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Affiliation(s)
- Xuemei Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province China
| | - Yuqing Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province China
| | - Chenxi Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province China
| | - Junjie Liu
- School of Statistics and Mathematics, Central University of Finance and Economics, Beijing, China
| | - Youwen Cui
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province China
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Systematic Review on the Impact of Guidelines Adherence on Antibiotic Prescription in Respiratory Infections. Antibiotics (Basel) 2020; 9:antibiotics9090546. [PMID: 32867122 PMCID: PMC7557871 DOI: 10.3390/antibiotics9090546] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 11/26/2022] Open
Abstract
Overuse and inappropriate antibiotic prescription for respiratory tract infections (RTI) are one of the major contributors to the current antibiotic resistance problem. Guidelines provide support to prescribers for proper decision-making. Our purpose is to review the impact of prescribers’ exposure to guidelines in antibiotic prescription for RTIs. A systematic review was performed searching in the scientific databases MEDLINE PubMed and EMBASE for studies which exposed prescribers to guidelines for RTI and compared antibiotic prescription rates/quality before and after the implementation, with thirty-four articles included in the review. The selected studies consisted on a simple intervention in the form of guideline implementation while others involved multifaceted interventions, and varied in population, designs, and settings. Prescription rate was shown to be reduced in the majority of the studies, along with an improvement in appropriateness, defined mainly by the prescription of narrow-spectrum rather than broad-spectrum antibiotics. Intending to ascertain if this implementation could decrease prescription costs, 7 articles accessed it, of which 6 showed the intended reduction. Overall interventions to improve guidelines adherence can be effective in reducing antibiotic prescriptions and inappropriate antibiotic selection for RTIs, supporting the importance of implementing guidelines in order to decrease the high levels of antibiotic prescriptions, and consequently reduce antimicrobial resistance.
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Kurotschka PK, Serafini A, Massari M, Da Cas R, Figueiras A, Forte V, Moro MF, Massidda M, Contu F, Minerba L, Marcias M, Nardelli M, Perra A, Carta MG, Spila Alegiani S. Broad Spectrum project: factors determining the quality of antibiotic use in primary care: an observational study protocol from Italy. BMJ Open 2020; 10:e038843. [PMID: 32636291 PMCID: PMC7342852 DOI: 10.1136/bmjopen-2020-038843] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The overuse of antibiotics is causing worldwide spread of antimicrobial resistance (AMR). Compared with other countries, Italy has both high antibiotic consumption rates and high rates of AMR. Due to the fact that around 90% of antibiotics are prescribed by general practitioners (GPs), this study aims to measure the impact of knowledge, attitudes and sociodemographic and workplace-related factors on the quality of antibiotic prescriptions filled by GPs in the Italian Region of Sardinia. METHODS AND ANALYSIS Knowledge, attitude, sociodemographic and workplace-related factors deemed to influence physicians prescribing behaviour will be evaluated in a cross-sectional study conducted among all GPs of the Italian Region of Sardinia (n=1200). A knowledge and attitudes questionnaire (Knowledge and Attitudes on Antibiotics and Resistance - Italian version: ITA-KAAR) accompanied by a sociodemographic form will be linked to drug prescription data reimbursed by the National Health System. European Surveillance of Antibiotic Consumption quality indicators for outpatient antibiotic use will be calculated from drug prescription records. Every GP will be deemed to have demonstrated an adequate quality of prescriptions of antibiotics if half of the indicator score plus one is better than the median of the region. A multivariate Poisson regression model with robust variance estimation will be used to evaluate the impact of the determinants of antibiotic prescriptions on the actual prescribing quality of each physician. ETHICS AND DISSEMINATION The project has been approved by the ethics committee of the Regional Health Trust of Sardinia (176/2019/CE, 24 September 2019). The results will be useful to inform evidence-based interventions to tackle irrational antibiotic use in the community.
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Affiliation(s)
- Peter Konstantin Kurotschka
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
- General Practitioner in Training, Primary Care Department, Regional Health Trust of Sardinia, Cagliari, Italy
| | - Alice Serafini
- General Practitioner in Training, Primary Care Department, Local Health Trust Modena, Modena, Italy
| | - Marco Massari
- National Centre for Pre-Clinical and Clinical Drug Research and Surveillance (CNRVF), Istituto Superiore di Sanita, Rome, Italy
| | - Roberto Da Cas
- National Centre for Pre-Clinical and Clinical Drug Research and Surveillance (CNRVF), Istituto Superiore di Sanita, Rome, Italy
| | - Adolfo Figueiras
- Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Viviana Forte
- General Practitioner, Primary Care Department, Regional Health Trust, Cagliari, Italy
| | | | - Matteo Massidda
- General Practitioner in Training, Primary Care Department, Regional Health Trust of Sardinia, Cagliari, Italy
| | - Federico Contu
- General Practitioner in Training, Primary Care Department, Regional Health Trust of Sardinia, Cagliari, Italy
| | - Luigi Minerba
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Maurizio Marcias
- Health Technology Assessment Unit, Regional Health Trust of Sardinia, Cagliari, Italy
| | - Marco Nardelli
- Brayford Square Surgery, Tower Hamlets Primary Care Trust, London, UK
| | - Alessandra Perra
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Mauro Giovanni Carta
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Stefania Spila Alegiani
- National Centre for Pre-Clinical and Clinical Drug Research and Surveillance (CNRVF), Istituto Superiore di Sanita, Rome, Italy
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