Distribution of educational materials
3.1. Distribution of educational materials
There were four studies (Angunawela et al., 1991; Avorn and Soumerai, 1983; Ray et al., 1985; Schaffner et al., 1983; Seppälä et al., 1997) in which physicians received printed educational materials regarding appropriate
Interventions to Improve Antibiotic Prescribing 501
Table 1. Distribution of educational materials Study
Results as reported citation
Design Analysis
Outcome measure
in the study Seppälä
2.40 DDD per 1,000 popln et al. (1997)
ITS No time
Reduction in use
series
in 1991 to 1.38 in 1992 analysis
of macrolide
( p ⫽ 0.007) reported
antibiotics
Avorn et al. Cluster No cluster Reduction in use Change in mean number (1983)
RCT analysis
of cephalexin
of units prescribed ⫺ 100 ( p ⫽ NS)
Angunawela Cluster No cluster Reduction in use Mean difference in proportion et al. (1991) RCT
analysis
of antibiotics for
of patients receiving
prescription of ⫺7.4% Schaffner
viral infections
CBA No cluster Reduction in use No difference et al. (1983)
analysis
of contraindicated
(numbers not given)
antibiotics and cephalosporins
term follow up data from a preceding study (Schaffner et al., 1983). These materials consisted of information regarding treatment of specific infectious conditions and/or recommendations regarding the use of certain medications (including at least one antibiotic). No materials referring to the specific physi- cian’s practice (i.e., audit of practice pattern with feedback) were sent. These educational materials were unsolicited and sent by mail (Avorn et al., 1983; Schaffner et al., 1983; Anunawela et al., 1991) or published in a national med- ical journal (Seppala et al., 1997).
There were two RCTs (one cluster RCT in which groups of healthcare workers rather than individuals are randomized), one CBA, and one ITS involving distribution of educational materials. One study aimed to reduce use of the oral cephalosporin, cephalexin (among other non-antibiotic medica- tions) in general practice and compared printed educational materials alone or combined with audit and feedback (see Section 3.2) to a no intervention con- trol group (Avorn and Soumerai, 1983). The second study compared the effect of printed educational materials with or without group educational seminars to controls (three study groups) on reducing inappropriate use of antibiotics for acute viral respiratory tract infections (Angunawela et al., 1991). In a CBA study from Tennessee, researchers compared a mailed educational brochure to an outreach visit by a pharmacist or physician (2 groups) and to controls to reduce the use of certain antibiotics (oral cephalosporins, clindamycin, tetra- cycline, and chloramphenicol) (Ray et al., 1985; Schaffner et al., 1983). Finally, Finnish medical authorities sought to reduce the use of erythromycin for Group A streptococcal infections with a published recommendation against
502 Sandra L. Arnold None of the first three studies showed any effect of printed educational
materials alone, in changing prescribing behavior. This was despite the fact that the lack of adjustment for clustering likely resulted in an overestimation of the intervention effect in these studies. The Finnish study demonstrated a sig- nificant reduction in macrolide antibiotic use following publication of the rec- ommendation which seemed to decay (not statistically significant) somewhat over time (by time-series analysis not presented in the published paper). Thus, written educational materials alone appear to have a limited impact overall with three of four studies demonstrating no change in prescribing behavior. The specific circumstances of the Finnish study, that is, there being an increase in resistance to macrolides in Group A streptococci may have substantially contributed to the effectiveness of the published recommendations in that par- ticular study. Interventions tailored to circumstances may, therefore, be more likely to be effective.
Parts
» Antibiotic Policies: Theory and Practice
» THEORIES OF FACILITATING CHANGE
» OTHER APPROACHES TO GUIDELINE DEVELOPMENT
» QUALITY ASSURANCE AND DEVELOPMENT OF STANDARDS
» DEVELOPMENT OF CLINICAL STANDARDS IN SCOTLAND
» WHICH QI INTERVENTIONS HAVE BEEN STUDIED IN CAP?
» LINKING PROCESS OF CARE TO OUTCOMES IN QI
» WHAT IS THE EVIDENCE THAT QI INITIATIVES IMPROVE PROCESS OF CARE IN CAP?
» WHAT IS THE EVIDENCE THAT QI INITIATIVES IMPROVE OUTCOMES IN CAP?
» Designing and implementing a CAP intervention
» LEVEL OF AGGREGATION OF ANTIMICROBIALS
» ANTIMICROBIAL USAGE MEASURES
» Relationships based on patient-specific data
» Relationships based on aggregate usage
» ANTIBIOTIC CONSUMPTION; ALTERNATIVE UNITS OF MEASUREMENT
» ANTIBIOTIC CONSUMPTION CALCULATOR
» BENCHMARKING FOR REDUCING VANCOMYCIN USE AND VANCOMYCIN- RESISTANT ENTEROCOCCI IN US ICU S
» THE HARVARD EMERGENCY DEPARTMENT QUALITY STUDY
» ANALYSIS BY INDIVIDUAL ANTIMICROBIAL AGENT
» BENCHMARKING WITH OTHER ANTIMICROBIAL UTILISATION DATA
» STATE OF THE ART OF ANTIBIOTIC PROPHYLAXIS IN SURGERY
» AUDITING AND IMPROVING THE QUALITY OF ANTIBIOTIC PROPHYLAXIS IN SURGERY
» TYPES OF STUDIES TO OBTAIN QUALITY DATA ON A PATIENT LEVEL
» MULTIDISCIPLINARY ANTIMICROBIAL MANAGEMENT TEAMS
» THE ROLE OF THE PHARMACIST IN INFECTION MANAGEMENT
» TRAINING AND SUPPORT IN INFECTION MANAGEMENT FOR PHARMACISTS
» ANTIBIOTIC POLICY IN THE TERTIARY CARE CENTRE
» ANTIBIOTIC CONSUMPTION IN ICU S
» ANTIBIOTIC RESISTANCE IN ICU
» The impact of antibiotic policies and antibiotic consumption on antibiotic resistance
» IT and benchmarking to improve antibiotic prescribing
» COST OF HOSPITAL-ACQUIRED INFECTION
» THE COST OF ANTIMICROBIAL RESISTANCE
» Costs of screening/surveillance cultures
» Isolation, cohorting, and contact isolation
» EPIDEMIOLOGY OF INVASIVE FUNGAL INFECTIONS
» Antifungal resistance in Candida species
» Antifungal resistance cannot be transmitted by extrachromosomal DNA
» RATIONAL USE OF ANTIFUNGAL AGENTS
» THE CHANGING FACE OF VIRAL INFECTIONS AND THEIR MANAGEMENT
» PROBLEMS ASSOCIATED WITH ANTIVIRAL THERAPY
» ANTIVIRAL TREATMENT STRATEGIES
» ANTIVIRAL PROPHYLAXIS STRATEGIES
» ANTIBIOTIC CONCENTRATIONS AT TARGET SITES
» An infant with aplastic anaemia
» A long-standing E. coli infection of liver cysts
» BREAKPOINTS: A SHORT HISTORY AND OVERVIEW
» PHARMACODYNAMIC RELATIONSHIPS AND EMERGENCE OF RESISTANCE
» EVALUATION OF THE ANTIMICROBIAL RESISTANCE SURVEILLANCE DATA PUBLISHED IN THE MEDICAL LITERATURE
» PRACTICAL ASPECTS OF THE IMPLEMENTATION OF THE SURVEILLANCE PROGRAM
» Multivariate analysis methods
» Evolutionary genetic approaches
» Study of the relationship between bacterial resistance and antimicrobial consumption
» To predict the short-term evolution of resistance
» To evaluate interventions to control antibiotic resistance
» DISINFECTANTS: TYPES, ACTIONS, AND USAGES
» Evidence of bacterial resistance to biocides
» Mechanisms of bacterial resistance to biocides
» EVIDENCE OF CROSS-RESISTANCE BETWEEN BIOCIDES AND ANTIBIOTICS
» DISINFECTANT USAGE AND ANTIBIOTIC RESISTANCE
» METHODS OF LITERATURE REVIEW
» PROBLEMS WITH INTERPRETATION OF PUBLISHED STUDIES
» Distribution of educational materials
» Audit and feedback with or without other educational materials
» Educational group meetings or seminars
» Educational outreach/academic detailing
» Financial/healthcare system changes
» EFFECT OF INTERVENTIONS ON ANTIBIOTIC RESISTANCE
» DDD/1,000 INHABITANTS AND DAY (DID)
» PRESCRIPTIONS/1,000 INHABITANTS AND YEAR
» INDICATIONS FOR ANTIBIOTIC PRESCRIPTIONS
» POSSIBLE CAUSES FOR OBSERVED VARIATIONS IN ANTIBIOTIC USE
» DETERMINANTS OF ANTIBIOTIC CONSUMPTION
» COLLECTIVE AWAKENING AND PROGRESSIVE MOBILIZATION OF FRENCH PUBLIC HEALTH AUTHORITIES
» ANTIBIOTIC USE AND COST TRENDS
» IMPACT ON HEALTH BUDGETS OF ANTIBIOTIC USE
» ACCESS TO ESSENTIAL ANTIBIOTICS AT ALL LEVELS OF CARE
» EPIDEMIOLOGY OF ANTIMICROBIAL RESISTANCE
» THREAT OF ANTIMICROBIAL RESISTANCE
» ECONOMIC IMPLICATIONS OF ANTIMICROBIAL RESISTANCE
» FACTORS CONTRIBUTING TO DEVELOPMENT AND SPREAD OF RESISTANCE
» STRATEGIES FOR CONTAINMENT OF RESISTANCE IN DEVELOPING COUNTRIES
» Antibacterial resistance and policies
» Policies, guidelines, and education on antibacterial use
» Discovery, development, and commercialization in the face of policies
» Antibacterial development, labelling, and benefits
» WHAT CAN BE DONE NOW ABOUT ANTIBIOTIC RESISTANCE?
» HOW CAN THE DIAGNOSTIC LABORATORY HELP?
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