An Electronic Health Record Integrated Decision Tool and Supportive Interventions to Improve Antibiotic Prescribing for Urinary Tract Infections in Nursing Homes: A Cluster Randomized Controlled Trial
| Autor: | Jeanine J.S. Rutten, Laura W. van Buul, Martin Smalbrugge, Suzanne E. Geerlings, Debby L. Gerritsen, Stephanie Natsch, Philip D. Sloane, Johannes C. van der Wouden, Jos W.R. Twisk, Cees M.P.M. Hertogh |
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| Přispěvatelé: | Elderly care medicine, APH - Aging & Later Life, APH - Quality of Care, Internal medicine, General practice, Epidemiology and Data Science, APH - Health Behaviors & Chronic Diseases, APH - Methodology, Infectious diseases, AII - Infectious diseases |
| Rok vydání: | 2022 |
| Předmět: |
education
Long-term care facilities Health Policy antibiotic stewardship General Medicine Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18] Anti-Bacterial Agents Nursing Homes Antimicrobial Stewardship All institutes and research themes of the Radboud University Medical Center lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4] Urinary Tract Infections Electronic Health Records Humans electronic decision support treatment decision tool Geriatrics and Gerontology urinary tract infection General Nursing |
| Zdroj: | Journal of the American Medical Directors Association. Elsevier Inc. Journal of the American Medical Directors Association, 23, 3, pp. 387-393 Journal of the American Medical Directors Association, 23(3), 387-393. Elsevier Inc. Journal of the American Medical Directors Association, 23, 387-393 Rutten, J J S, van Buul, L W, Smalbrugge, M, Geerlings, S E, Gerritsen, D L, Natsch, S, Sloane, P D, van der Wouden, J C, Twisk, J W R & Hertogh, C M P M 2021, ' An Electronic Health Record Integrated Decision Tool and Supportive Interventions to Improve Antibiotic Prescribing for Urinary Tract Infections in Nursing Homes : A Cluster Randomized Controlled Trial ', Journal of the American Medical Directors Association . https://doi.org/10.1016/j.jamda.2021.11.010 |
| ISSN: | 1525-8610 |
| Popis: | OBJECTIVE: To investigate whether an electronic health record (EHR)-integrated decision tool, combined with supportive interventions, results in more appropriate antibiotic prescribing in nursing home (NH) residents with suspected urinary tract infection (UTI), without negative consequences for residents.DESIGN: Cluster randomized controlled trial with NHs as the randomization unit; intervention group NHs received the EHR-integrated decision tool and supportive interventions, and control group NHs provided care as usual.SETTING AND PARTICIPANTS: 212 residents with suspected UTI, from 16 NHs in the Netherlands.METHODS: Physicians collected data at index consultation (ie, UTI suspicion) and during a 21-day follow-up period (March 2019-March 2020). Overall antibiotic prescribing data at NH level, 12 months prior to and during the study, was derived from the electronic prescribing system. The primary study outcome was the percentage of antibiotic prescriptions for suspected UTI that was appropriate, at index consultation. Secondary study outcomes included changes in treatment decision, complications, UTI-related hospitalization, and mortality during follow-up; and pre-post study changes in antibiotic prescribing at the NH level.RESULTS: 295 suspected UTIs were included (intervention group: 189; control group: 106). The between-group difference in appropriate antibiotic prescribing was 13% [intervention group: 62%, control group: 49%; adjusted odds ratio (OR) 1.43, 95% CI 0.57-3.62]. In both groups, complications (2% vs 3%), UTI-related hospitalization (2% vs 1%), and possible UTI-related mortality (2% vs 2%) were rare. The pre-post study difference in antibiotic prescriptions per 1000 resident-care days was -0.95 in the intervention group NHs and -0.05 in the control group NHs (P = .02).CONCLUSION AND IMPLICATIONS: Although appropriate antibiotic prescribing improved in the intervention group, this does not provide sufficient evidence for our multidisciplinary intervention. Despite this inconclusive result, our intervention could potentially still be effective, because we established a large reduction in the number of antibiotic prescriptions in the intervention group. |
| Databáze: | OpenAIRE |
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