Audit and feedback with or without other educational materials
3.2. Audit and feedback with or without other educational materials
The process of audit and feedback refers to the collection and analysis of individual or group prescribing data followed by distribution of these materials back to prescribing physicians. Additional materials distributed accompanying the feedback material may include any one or more of the following: an expla- nation of the prescribing data, comparative data for other physicians or groups of physicians, and educational materials promoting more optimal prescribing practices. Audit and provision of feedback data may also be a part of the infor- mation provided at individual or group educational meetings or seminars. In this section, only those studies involving distribution of written audit material with or without accompanying comparative data and/or printed educational materials are considered. This type of intervention has been popular as it is rel- atively simple and inexpensive to perform. This means that even modest reduc- tions in inappropriate prescribing may result in substantial cost savings for insurers although the impact on antibiotic resistance may be less impressive.
There were four studies, three RCTs (Hux et al., 1999; Mainous et al., 2000) (one cluster RCT [O’Connell et al., 1999]) and one CBA trial (Rokstad et al., 1995), in this category (Table 2). In the first RCT (Mainous et al., 2000), authors examined the effect of audit and feedback alone and audit and feed- back with patient educational materials compared with a no intervention con- trol group in an intervention designed to reduce antibiotic prescribing for viral pediatric respiratory tract infection. The second study (Hux et al., 1999), com- pared the effect of audit and feedback to controls on the prescribing of recom- mended first-line antibiotics for community-acquired infections to senior
Interventions to Improve Antibiotic Prescribing 503
Table 2. Audit and feedback Study
Results as reported citation
Design Analysis
Outcome
in the study Mainous
measure
Overall increase in et al. (2000) RCT
Cluster No cluster
Reduction in
analysis
antibiotic use
proportion of patients with
for viral URI
colds having prescriptions, gain scores compared with controls significantly lower by Dunnett’s T ( p ⬍ 0.05)
Hux et al. RCT No cluster
Change of 2.5% in (1999)
Increase in
analysis
prescribing of
intervention compared
first-line
with ⫺1.7% in controls
( p ⬍ 0.01) O’Connell
agents
No change in median et al. (1999) RCT
Cluster Acknowledged
Reduction in
intracluster
prescribing rates per correlations for
overall
100 medicare services sample size calculations but did not use in analysis
antibiotic use
Rokstad CBA No cluster
Increase in mean number et al. (1995)
Increase
analysis
prescribing of
of prescriptions for
first-line
trimethoprim of 32.5
agents for
(3.5–61.7) in intervention
UTI
group and reduction in control group ⫺31.8 (⫺54.7 to ⫺3.5)
citizens. In the cluster RCT (O’Connell et al., 1999), physicians were random- ized by postal code regions to receive audit and feedback on the prescribing of oral antibiotics (and four other classes of medication) or no intervention. Finally, in the CBA study (Rokstad et al., 1995), Norwegian general practi- tioners received audit and feedback material along with clinical practice guide- lines for the management of urinary tract infection (UTI) in women (diagnostic, first-line antibiotics, duration of therapy), with a control group receiving similar information on the management of insomnia.
In these studies, audit and feedback with or without written educational materials or prescribing guidelines had little or no impact on antibiotic pre- scribing in general terms. Two studies demonstrated no significant change in prescribing behavior in response to the intervention (Mainous et al., 2000; O’Connell et al., 1999). The remaining two studies (Hux et al., 1999; Rokstad et al., 1995) showed a small but statistically significant increase in the prescribing of recommended first-line antibiotics. In none of these studies was
504 Sandra L. Arnold appropriate statistical analysis to account for clustering of patients within physi-
cians undertaken and thus, the results of the latter two studies might be rendered nonsignificant on reanalysis. The results from these studies indicate that there may be certain prescribing situations that are more amenable to interventions such as those studies seeking to increase prescribing of certain selected “first- line” agents. In contrast, interventions aimed at reducing antibiotic overuse (for viral infections, for example) may require more complex interventions.
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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