Unsolicited post-prescription antibiotic review in surgical and medical wards: factors associated with counselling and physicians' compliance.
The purpose of this investigation was to describe the impact of an early review of antibiotic prescriptions in a hospital using unsolicited infectious disease physician (IDP) counselling, identify areas for improvement and examine factors associated with physicians' non-compliance. The prescriptions of 15 selected antibiotics from surgical or medical wards were screened daily and reviewed between days 3 and 5 by a single IDP during an 8-month period to identify those likely needing counselling. Improved antibiotic use was sought by encouraging ward physicians to withdraw or de-escalate therapy, promoting oral switch or reducing the duration of therapy whenever appropriate. Variables potentially associated with IDP counselling and physicians' non-compliance were tested using bivariate analysis and then entered in a logistic regression model. Among 857 prescriptions analysed, 54.6 % prompted unsolicited counselling, mostly for stopping therapy (18.8 %), reducing its duration (18.0 %) or de-escalation (13.0 %). Variables independently associated with IDP counselling included antibiotic combination (adjusted odds ratio [aOR], 5.27 [95 % confidence interval (CI), 1.80-15.45]; p = 0.002), non-clinically documented infection (aOR, 4.98 [95 % CI, 2.81-8.82]; p < 0.001) and microbiologically documented infection (aOR, 2.04 [95 % CI, 1.51-2.75]; p < 0.001). The physicians' compliance rate was 77.3 %. Variables independently associated with physicians' non-compliance to the IDP recommendation were the surgical speciality of the ward physician (aOR, 1.91 [95 % CI, 1.17-3.12]; p = 0.009) and advice to reduce the duration of therapy (aOR, 1.88 [95 % CI, 1.12-3.15]; p = 0.017). An unsolicited post-prescription antibiotic review can be successfully implemented with a high rate of physicians' compliance. Areas for targeting improvement measures include prescriptions in surgical wards and shortening the duration of therapy.
Unité de Contrôle, Epidémiologie et Prévention de l'Infection, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Université Paris 12, Créteil, France. philippe.lesprit@hmn.aphp.fr
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Lesprit
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Landelle
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Brun-Buisson
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003376:Counseling / Q000706:statistics & numerical data; D011307:Drug Prescriptions / Q000592:standards*; D004363:Drug Utilization / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006302:Health Services Research; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians
D000900:Anti-Bacterial Agents