Evaluating antibiotic use and developing a tool to optimize prescribing in a family-centered HIV clinic in Eswatini

Autor: Alexander W. Kay, Bhekumusa Lukhele, Tara E. Ness, Ashish E. Streatfield, Tandzile T Simelane, Danielle Guffey, Abiy Korsa, Sandile Dlamini
Rok vydání: 2020
Předmět:
Male
RNA viruses
Quality management
Pulmonology
Economics
Health Care Providers
Antibiotics
Human immunodeficiency virus (HIV)
Social Sciences
HIV Infections
Inappropriate Prescribing
Economic Geography
medicine.disease_cause
Pathology and Laboratory Medicine
Ambulatory Care Facilities
Infographics
Chi Square Tests
Mathematical and Statistical Techniques
Medical Conditions
Immunodeficiency Viruses
Surveys and Questionnaires
Medicine and Health Sciences
Medical Personnel
Child
Data Management
Multidisciplinary
Geography
Antimicrobials
Statistics
Drugs
Antimicrobial
Charts
Test (assessment)
Anti-Bacterial Agents
Professions
Infectious Diseases
Medical Microbiology
Viral Pathogens
Viruses
Physical Sciences
Medicine
Low and Middle Income Countries
Female
Pathogens
Research Article
Adult
medicine.medical_specialty
Computer and Information Sciences
Adolescent
medicine.drug_class
Science
MEDLINE
Research and Analysis Methods
Drug Prescriptions
Microbiology
Young Adult
Respiratory Disorders
Microbial Control
Physicians
Retroviruses
Chi-square test
medicine
Humans
Family
Medical prescription
Statistical Methods
Microbial Pathogens
Statistical Hypothesis Testing
Retrospective Studies
Pharmacology
business.industry
Data Visualization
Lentivirus
Organisms
Biology and Life Sciences
HIV
Health Care
Emergency medicine
People and Places
Respiratory Infections
Earth Sciences
Population Groupings
business
Eswatini
Mathematics
Zdroj: PLoS ONE
PLoS ONE, Vol 16, Iss 1, p e0244247 (2021)
ISSN: 1932-6203
Popis: In a human immunodeficiency virus (HIV) clinic for children and their families in Eswatini, we sought to understand the use of antibiotics and identify specific areas for improvement. We performed a retrospective patient chart review as part of a quality improvement (QI) initiative to assess antimicrobial use before and after implementation of a standardized antimicrobial guide. For each prescribing period, 100 random patient encounters were selected for review if the indication for antibiotics, duration, and dose were consistent with World Health Organization (WHO) guidelines. Two physicians reviewed each encounter using a structured abstraction tool, with a third resolving discrepancies. Results were analyzed using a chi-square test of proportions and a structured survey was performed to assess perceptions of the guide. After the implementation of an antimicrobial guide, there was a significant decrease in the proportion of clinic visits with an antibiotic prescribed (p < 0.001). Incorrect indication for antimicrobial use decreased from 20.4% in the initial period to 10.31% and 10.2% but did not reach significance (p = .0621) in the subsequent periods after implementation. Incorrect dose/duration decreased from 10.47% in the initial period to 7.37% and 3.1% in the subsequent periods, but this was also was not significant (p = 0.139). All prescribers who completed the survey felt that it positively impacted their prescribing. Our study found that an antimicrobial guide reduced and improved the prescription of antimicrobials, demonstrating practical solutions can have a lasting impact on prescribing in low resource settings.
Databáze: OpenAIRE
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