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An Educational Intervention to Improve Antimicrobial Use in a Hospital‐Based Long‐Term Care Facility
Author(s) -
Schwartz David N.,
Abiad Homer,
DeMarais Patricia L.,
Armeanu Emilian,
Trick William E.,
Wang Yue,
Weinstein Robert A.
Publication year - 2007
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2007.01251.x
Subject(s) - medicine , guideline , psychological intervention , long term care , academic detailing , antimicrobial , cohort , emergency medicine , acute care , cohort study , interrupted time series , antimicrobial stewardship , intervention (counseling) , intensive care medicine , family medicine , pediatrics , antibiotic resistance , health care , nursing , antibiotics , chemistry , organic chemistry , pathology , microbiology and biotechnology , economics , biology , economic growth
OBJECTIVES: To improve antimicrobial use in patients receiving long‐term care (LTC). DESIGN: Prospective, quasi‐experimental before–after assessment of the effects of physician education and guideline implementation. SETTING: Public LTC and acute care hospital. PARTICIPANTS: Twenty salaried internists who provided most of the medical care to LTC patients. INTERVENTION: National guidelines, hospital resistance data, and physician feedback were incorporated into a series of four teaching sessions presented over 18 months and into booklets detailing institutional guidelines on the optimal management of common LTC infection syndromes. MEASUREMENTS: One hundred randomly selected LTC patients treated with antimicrobials were reviewed before these interventions were implemented and 100 after, and measures of the quality of care were compared. The effect of the interventions on antimicrobial days and starts were also assessed using interrupted time series analysis. RESULTS: Charted clinical abnormalities met guideline diagnostic criteria (62% vs 38%, P =.006), and initial therapy agreed with guideline recommendations (39% vs 11%, P <.001), more often in the post‐ than in the preintervention cohort. Mean census‐adjusted monthly LTC antimicrobial days fell 29.7%, and antimicrobial starts fell 25.9% during the intervention period; both decreases were sustained during the 2‐year postintervention period. CONCLUSION: The teaching and guideline intervention improved the quality and reduced the quantity of antimicrobial use in LTC patients.