An educational intervention to improve antimicrobial use in a hospital-based long-term care facility.
OBJECTIVE
To improve antimicrobial use in patients receiving long-term care (LTC).


METHODS
Prospective, quasi-experimental before-after assessment of the effects of physician education and guideline implementation.


METHODS
Public LTC and acute care hospital.


METHODS
Twenty salaried internists who provided most of the medical care to LTC patients.


METHODS
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.


METHODS
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.


CONCLUSIONS
The teaching and guideline intervention improved the quality and reduced the quantity of antimicrobial use in LTC patients.
Division of Infectious Diseases, Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois 60612, USA. david.schwartz@hektoen.org
David N
DN
Schwartz
Homer
H
Abiad
Patricia L
PL
DeMarais
Emilian
E
Armeanu
William E
WE
Trick
Yue
Y
Wang
Robert A
RA
Weinstein
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004363:Drug Utilization / Q000706:statistics & numerical data; D004501:Education, Medical; D005260:Female; D019983:Guideline Adherence; D006268:Health Facilities; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
D000900:Anti-Bacterial Agents