Quantitative evaluation of a clinical intervention aimed at changing prescriber behaviour in response to new guidelines.
OBJECTIVE
The objective of the study was to assess prescribers' compliance with guidelines for acute community-acquired pneumonia management in a paediatric university hospital centre before and after its dissemination.


METHODS
This quasi-experimental study without a control group was conducted before and after new community-acquired pneumonia management guidelines were disseminated in a tertiary care paediatric hospital. The pre-intervention (baseline) period was from October 2004 to March 2005. The intervention period was divided into two phases: (1) October 2005 to January 14, 2006 (consultation by peer leaders and networking) and (2) January 15, 2006, to March 2006 (dissemination of official guidelines and of a pre-printed prescription sheet, an educational session led by a peer leader for residents and further networking). We used a compliance score to assess prescriptions written by prescribers who practised in the units where the guidelines had to be followed.


RESULTS
The study included a total of 1151 prescriptions. The prescription compliance with the guidelines increased from 131/652 (20.1%) in the pre-intervention period to 264/499 (52.9%) in the post-intervention intervention period: a difference of 32.8% (CI 95% 27.4-38.0). Similar results were found if analysed according to affiliation (emergency department or wards). An inappropriate choice of antibiotic agent represented 347/521 (66.6%) of the causes of non-compliance in the pre-intervention period and 99/235 (42.1) in the intervention period: a difference of -24.5% (95% CI -31.8, -16.8).


CONCLUSIONS
Guideline dissemination for the management of acute community-acquired pneumonia significantly increased prescriber compliance in the emergency department and on wards.
Doyon
Sophie
S
Department of Pharmacy and Research Unit of Pharmacy Practice, CHU Sainte-Justine, Montreal, QC, Canada.
Perreault
Mélissa
M
Marquis
Christopher
C
Gauthier
Josianne
J
Lebel
Denis
D
Bailey
Benoit
B
Collin
Johanne
J
Bussières
Jean-François
JF
D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D017714:Community-Acquired Infections / Q000188:drug therapy*; D004636:Emergency Service, Hospital; D005260:Female; D019983:Guideline Adherence; D006776:Hospitals, Pediatric; D006801:Humans; D016015:Logistic Models; D008297:Male; D011014:Pneumonia / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D011792:Quebec
D000900:Anti-Bacterial Agents