title: Can a multifaceted educational intervention targeting both nurses and physicians change the prescribing of antibiotics to nursing home residents? A cluster randomized controlled trial.
abstract: OBJECTIVE
  To assess the impact of a multifaceted educational intervention concerning treatment of infections in the nursing home setting.
  
  
  METHODS
  We used a cluster randomized controlled trial. Fifty-eight nursing homes in Sweden were randomly assigned either to educational intervention or control. The intervention consisted of small educational group sessions with nurses and physicians, feedback on prescribing, presentation of guidelines and written materials. The primary outcome was the proportion of quinolones prescribed for lower urinary tract infection (UTI) in women. Secondary outcomes were for all infections: number of UTIs per resident, proportion of recorded infections treated with an antibiotic, proportion of infections handled by physicians as 'wait and see', and for lower UTI in women, proportion of nitrofurantoin.
  
  
  RESULTS
  Of the 58 nursing homes, 46 completed the study. A total of 702 and 540 infections were recorded pre- and post-intervention. The proportion of quinolones decreased significantly in the intervention and control groups, by -0.196 (9/93 to 36/123) and -0.224 (4/66 to 31/109), respectively [95% confidence interval (CI) -0.338, -0.054 and -0.394, -0.054], but the difference between intervention and control groups was not significant, with an absolute risk reduction of 0.028 (95% CI -0.193, 0.249). The changes in proportion of infections treated with antibiotics and proportion of infections handled by physicians as 'wait and see' was significant in comparison with controls: -0.124 (95% CI -0.228, -0.019) and 0.143 (95% CI 0.047, 0.240). No intervention effect could be seen for the other outcomes.
  
  
  CONCLUSIONS
  The educational intervention had no effect on the primary outcome, but decreased the overall prescribing of antibiotics.
authors: Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Nobels väg 9, SE-171 77 Stockholm, Sweden. eva.pettersson@ki.se
authors: Eva
authors: E
authors: Pettersson
authors: Asa
authors: A
authors: Vernby
authors: Sigvard
authors: S
authors: Mölstad
authors: Cecilia Stålsby
authors: CS
authors: Lundborg
mesh_terms: D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D003695:Delivery of Health Care; D004334:Drug Administration Schedule; D016903:Drug Monitoring / Q000379:methods; D004363:Drug Utilization / Q000706:statistics & numerical data*; D004501:Education, Medical; D004506:Education, Nursing; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008134:Long-Term Care; D009582:Nitrofurantoin / Q000008:administration & dosage / Q000627:therapeutic use; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D015363:Quinolones / Q000008:administration & dosage / Q000627:therapeutic use; D014552:Urinary Tract Infections / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents; D015363:Quinolones; D009582:Nitrofurantoin