Effect of tailored antibiotic stewardship programmes on the appropriateness of antibiotic prescribing in nursing homes.
OBJECTIVE
To evaluate the effect of tailored interventions on the appropriateness of decisions to prescribe or withhold antibiotics, antibiotic use and guideline-adherent antibiotic selection in nursing homes (NHs).


METHODS
We conducted a quasi-experimental study in 10 NHs in the Netherlands. A participatory action research (PAR) approach was applied, with local stakeholders in charge of selecting tailored interventions based on opportunities for improved antibiotic prescribing that they derived from provided baseline data. An algorithm was used to evaluate the appropriateness of prescribing decisions, based on infections recorded by physicians. Effects of the interventions on the appropriateness of prescribing decisions were analysed with a multilevel logistic regression model. Pharmacy data were used to calculate differences in antibiotic use and recorded infections were used to calculate differences in guideline-adherent antibiotic selection.


RESULTS
The appropriateness of 1059 prescribing decisions was assessed. Adjusting for pre-test differences in the proportion of appropriate prescribing decisions (intervention, 82%; control, 70%), post-test appropriateness did not differ between groups (crude: P = 0.26; adjusted for covariates: P = 0.35). We observed more appropriate prescribing decisions at the start of data collection and before receiving feedback on prescribing behaviour. No changes in antibiotic use or guideline-adherent antibiotic selection were observed in intervention NHs.


CONCLUSIONS
The PAR approach, or the way PAR was applied in the study, was not effective in improving antibiotic prescribing behaviour. The study findings suggest that drawing prescribers' attention to prescribing behaviour and monitoring activities, and increasing use of diagnostic resources may be promising interventions to improve antibiotic prescribing in NHs.
EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands Department of General Practice & Elderly Care Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands l.vanbuul@vumc.nl.
Laura W
LW
van Buul
EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands Department of General Practice & Elderly Care Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
Jenny T
JT
van der Steen
Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, 2300 RC Leiden, The Netherlands.
Wilco P
WP
Achterberg
EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands Department of General Practice & Elderly Care Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands Netherlands Institute for Health Services Research, Otterstraat 118-124, 3513 CR Utrecht, The Netherlands.
François G
FG
Schellevis
Dutch Institute for Rational Use of Medicine, Churchilllaan 11, 3527 GV Utrecht, The Netherlands.
Rob T G M
RT
Essink
Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands.
Sabine C
SC
de Greeff
Department of Pharmacy, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands.
Stephanie
S
Natsch
Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr Blvd, Chapel Hill, NC 27599-7590, USA Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, Chapel Hill, NC 27599, USA.
Philip D
PD
Sloane
Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr Blvd, Chapel Hill, NC 27599-7590, USA School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro St, Chapel Hill, NC 27599-3550, USA.
Sheryl
S
Zimmerman
EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands Department of Epidemiology and Biostatistics, VU University Medical Center, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands.
Jos W R
JW
Twisk
EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands Department of General Practice & Elderly Care Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
Ruth B
RB
Veenhuizen
EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands Department of General Practice & Elderly Care Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
Cees M P M
CM
Hertogh
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D001424:Bacterial Infections / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000592:standards*; D004363:Drug Utilization / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D065228:Non-Randomized Controlled Trials as Topic; D009735:Nursing Homes
D000900:Anti-Bacterial Agents
appropriateness of prescribing decisions; guideline-adherent antibiotic selection; participatory action research