Patient-based interventions
3.7. Patient-based interventions
In several studies, patient-based interventions were evaluated in conjunc- tion with other interventions. There were, however, five studies that examined the effect of a variety of patient-based interventions alone (Table 7). These studies evaluated the effect of patient educational materials (Mainous et al., 2000), a patient information leaflet regarding antibiotics for acute bronchitis (Macfarlane et al., 2002) and the use of delayed prescriptions for infections where patients desired antibiotics but physicians did not feel antibiotics were necessary (Arroll et al., 2002; Dowell et al., 2001; Little et al., 2001).
In the one study examining the effect of patient educational materials alone (Mainous et al., 2000), there was a modest effect seen in the group with this intervention compared with the control group. This effect was similar to that seen in the other intervention groups (audit and feedback alone, or combined with patient educational materials). In a study of prescribing for acute bron- chitis in adults (Macfarlane et al., 2002), patients who were not felt to need antibiotics by the physician but appeared to desire a prescription received a prescription along with either a flyer explaining why antibiotics were unneces- sary for this condition or a blank leaflet. Patients in the intervention group were less likely to fill their prescriptions than those in the control group.
Three additional studies, utilizing the same concept, randomized patients
514 Sandra L. Arnold
Table 7. Patient-mediated interventions Study
Results as reported in citation
Design Analysis
Outcome
measure the study MacFarlane RCT—
Proportion of patients et al. (2002) patient
No cluster
Reduction in
filling prescription 47% randomized required
analysis
number of
patients filling
in intervention vs 62% in prescription for control; hazard ratio antibiotic for
for taking antibiotic for acute bronchitis intervention compared with control 0.66 (0.46–0.96)
Overall increase in propor- et al. (2000)
Mainous RCT No cluster
Reduction in
analysis
number of
tion of patients with colds
prescriptions
with prescriptions—gain
for URI
score compared with controls significantly lower by Dunnett’s T (p ⬍ 0.05)
Arroll et al. RCT— No cluster
48% of patients in delayed (2002)
Reduction in
patient analysis
prescription group filled randomized required
the number of
patients filling
prescription vs 89% in
prescriptions
controls; odds ratio for filling
for URI
prescription for delayed prescription 0.12 (0.05–0.29)
Dowell RCT— No cluster
45% of patients in delayed et al. (2001) patient
Reduction in
prescription group received a randomized required
analysis
the number of
patients filling
prescription vs 82% in the
prescriptions
control group (information
obtained from authors) Little et al.
for URI
24% of patients in delayed (2001)
RCT— No cluster
Reduction in
patient analysis
prescription group filled a randomized required
the number of
patients filling
prescription vs 98% in the
prescriptions
control group
for otitis media
(3–7 days depending on the study) if symptoms did not improve. In the two studies of adult patients with the common cold, patients were much less likely to fill the prescription in the delayed group (Arroll et al., 2002; Dowell et al., 2001). A similar effect of delayed prescriptions was seen in the study of prescribing for otitis media in children (Little et al., 2001).
The attractiveness of this type of intervention is that physicians advise against the need for an antibiotic for viral infections while still feeling that they have satisfied perceived patient demands. Indeed, some of the physicians in these studies felt that they would continue to use this intervention with demanding patients. Ultimately, the goal is that the patient will not fill the pre- scription and recover from the illness with the knowledge that an antibiotic
Interventions to Improve Antibiotic Prescribing 515 was not necessary. He or she may then be less inclined to request a prescription
during the next illness or possibly even forgo a visit to the physician for this problem as he or she now knows that it is benign and self-limited. One could argue, however, that giving a patient a prescription when it is not necessary sends a mixed message and places the onus of the decision on the patient. Simply taking the time to explain why an antibiotic is not necessary may accomplish the same goal.
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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