Enhanced physician adherence to antibiotic use guidelines through increased availability of guidelines at the time of drug ordering in hospital setting.
OBJECTIVE
Some studies have shown that making practice guidelines accessible to physicians when they are making clinical decisions could improve prescribing practices. The aim of the study was to assess the benefit of impact on physician adherence of the intervention that consisted of embedding previously paper-based antibiotic guidelines in the computerized physician drug order entry system of a teaching hospital in order to make these guidelines available to physician at the time of antibiotic ordering. Before the intervention, these guidelines were available in booklet form in all the wards of the hospital.


METHODS
Adherence to guidelines was evaluated in 471 consecutive antibiotic orders for pneumonia, 104 just before and 367 just after the intervention. The evaluation criteria were: the choice of the antibiotic relative to the context of acquisition of pneumonia, the daily dose, the planned duration of treatment. Evaluation of antibiotic orders was performed at the initiation of antibiotic treatment.


RESULTS
The intervention was followed by a significant decrease in the proportion of antibiotic orders containing at least one criterion of non-conformity to the guidelines, respectively, 33% after vs. 51% (p<0.001) before the intervention. Proportion of non-conform orders decreased in the post- vs. pre-intervention period for the daily dosage of antibiotics, respectively, 12.2% vs. 26.9% (p<0.001), for the planned duration of treatment, respectively, 7.3% vs. 18.3% (p<0.001), whereas for the choice of antibiotics relative to the context of acquisition of pneumonia, the improvement failed to reach statistical significance, respectively, 18.2% vs. 25% (p=0.12).


CONCLUSIONS
In this study, the increased availability of antibiotic guidelines at the time of drug ordering, combined with a periodical reinforcement educational round, was associated with an enhanced physician adherence to these guidelines.
Department of General and Geriatric Medicine, Hospital Centre, Strasbourg-Brumath, France. westphal-jfa@orange.fr
Jean-Frederic
JF
Westphal
Francois
F
Jehl
Herve
H
Javelot
Cathy
C
Nonnenmacher
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D016303:Clinical Pharmacy Information Systems / Q000706:statistics & numerical data; D020000:Decision Support Systems, Clinical; D011307:Drug Prescriptions; D004360:Drug Therapy, Computer-Assisted; D004363:Drug Utilization; D005260:Female; D005602:France; D019983:Guideline Adherence; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems / Q000706:statistics & numerical data; D008875:Middle Aged; D010607:Pharmacy Service, Hospital / Q000706:statistics & numerical data; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D015397:Program Evaluation; D013997:Time Factors
D000900:Anti-Bacterial Agents