Alternative indicators for monitoring the quality of a continuous intervention program on antibiotic prescribing during changing healthcare conditions.
We recently published on the impact of a four-phase hospital-wide intervention program designed to optimize the quality of antibiotic use, where a multidisciplinary team (MDT) could modify prescription at the last phase. Because health care quality was changing during the last 5 years (late 1999 to early 2004), we developed certain indicators to monitor the quality of our intervention over time. Different periods were defined as baseline (pre-intervention), initial intervention-active control, pre-crisis control, crisis control, post-crisis control and end of crisis control. Major indicators were rates of prescription modification by the MDT; prescription for an uncertain infection and a novel index formula (RIcarb) to estimate the rationale for carbapenem use. We assessed 2115 antimicrobial prescriptions. Modification of prescription rate was 30% at the beginning and decreased thereafter up to stable levels. Rate of prescriptions ordered for cases of both uncertain infection and unknown source of infection decreased significantly after intervention (i.e. from baseline to active control). In contrast, a doubling of culture-directed prescriptions was observed between these periods. RIcarb values lower and higher than 60% (modal, cut-off) were assumed as carbapenem overuse and underuse, respectively. Overuse was observed at the pre-intervention, while pronounced underuse was shown during the crisis (RIcarb, 45% and 87%, respectively). The present study demonstrates that certain indicators, other than the widely adopted impact outcomes, are a suitable tool for monitoring the quality of a continuous, long-term, active intervention on antimicrobial prescribing practice, especially when applied in a changing healthcare setting.
Bantar
C
C
Services of Infection Control, Hospital San Martin, Parana, Entre Rios, Argentina. cbantar@arnet.com.ar
Franco
D
D
Heft
C
C
Vesco
E
E
Arango
C
C
Izaguirre
M
M
Alcázar
G
G
Boleas
M
M
Oliva
M E
ME
D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D015780:Carbapenems / Q000627:therapeutic use; D003695:Delivery of Health Care / Q000592:standards / Q000639:trends; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D024881:Drug Resistance, Bacterial; D006744:Hospital Bed Capacity, 100 to 299; D006801:Humans; D007400:Interprofessional Relations; D008137:Longitudinal Studies; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care
D000900:Anti-Bacterial Agents; D015780:Carbapenems