title: Impact of a decision-making aid for suspected urinary tract infections on antibiotic overuse in nursing homes.
abstract: BACKGROUND
  Antibiotics are highly utilized in nursing homes. The aim of the study was to test the effectiveness of a decision-making aid for urinary tract infection management on reducing antibiotic prescriptions for suspected bacteriuria in the urine without symptoms, known as asymptomatic bacteriuria (ASB) in twelve nursing homes in Texas.
  
  
  METHODS
  A pre- and post-test with comparison group design was used. The data was collected through retrospective chart review. The study sample included 669 antibiotic prescriptions for suspected urinary tract infections ordered for 547 nursing home residents. The main measurement for the outcome variable was whether an antibiotic was prescribed for suspected urinary tract infections with no symptoms present.
  
  
  RESULTS
  Most of the prescriptions for antibiotics UTIs were written without documented symptoms - thus for asymptomatic bacteuria (ASB) (71 % during the pre-intervention period). Exposure to the decision-making aid decreased the number of prescriptions written for ASB (from 78 % to 65 % in the low-intensity homes and from 65 % to 57 % in the high-intensity homes), and decreased odds of a prescription being written for ASB (OR = 0.63, 95 % CI = 0.25 - 1.60 for low-intensity homes; OR = 0.79, 95 % CI = 0.33 - 1.88 for high-intensity homes). The odds of a prescription being written for ASB decreased significantly in homes that succeeded in implementing the decision-making aid (OR = 0.35, 95 % CI = 0.16-0.76), compared to homes with no fidelity.
  
  
  CONCLUSIONS
  The decision-making aid improved antibiotic stewardship in nursing homes.
authors.affiliation: Texas A&M University, College Station, USA.|Department of Health Policy & Management, School of Public Health, 1266 TAMU, College Station, TX, 77843, USA.
authors.forename: Darcy K
authors.initials: DK
authors.lastname: McMaughan
authors.affiliation: Texas A&M University, College Station, USA.
authors.forename: Obioma
authors.initials: O
authors.lastname: Nwaiwu
authors.affiliation: Texas A&M University, College Station, USA.
authors.forename: Hongwei
authors.initials: H
authors.lastname: Zhao
authors.affiliation: American Institutes for Research, Washington, D.C, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Frentzel
authors.affiliation: University of Missouri School of Medicine, Columbia, USA.
authors.forename: David
authors.initials: D
authors.lastname: Mehr
authors.affiliation: Texas A&M University, College Station, USA. Imanpour@tamhsc.edu.
authors.forename: Sara
authors.initials: S
authors.lastname: Imanpour
authors.affiliation: American Institutes for Research, Washington, D.C, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Garfinkel
authors.affiliation: Texas A&M University, College Station, USA.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Phillips
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001437:Bacteriuria / Q000175:diagnosis / Q000188:drug therapy / Q000451:nursing; D003661:Decision Support Techniques; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D009733:Nursing Diagnosis; D009735:Nursing Homes; D000067490:Prescription Drug Overuse / Q000451:nursing* / Q000517:prevention & control*; D012189:Retrospective Studies; D014481:United States; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000451:nursing*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic stewardship; Antibiotics; Asymptomatic bacteriuria; Nursing home; Urinary tract infection