Abstract：
BACKGROUND: This study was designed to evaluate the sustainability of the impact of educational programs provided by pharmacists on the appropriateness of surgical antibiotic prophylaxis and cost-savings in a short time and a long time after the intervention.
METHODS: This prospective educational interventional study was conducted in a tertiary referral hospital for surgery in the West of Iran from September 2018 to October 2019. The study was designed in three phases: pre-intervention phase, short term after the intervention, and six months after the intervention. Within a one month course, several educational sessions regarding the appropriate preoperative antibiotic prophylaxis based on the recommendations of the American Society of Health-System Pharmacists guideline (ASHPs) were provided by a clinical pharmacist in an interactive manner for the surgeons. The appropriateness of antibiotic prophylaxis regarding the necessity for surgical antibiotic prophylaxis use (indication), the choice of antibiotic, the timing of antibiotic administration, the route of administration, the dose of antibiotics, and the total duration of antibiotic prophylaxis were evaluated and compared before and after the educational intervention. Additionally, medication-related costs, non-medication-related costs, antibiotic prophylaxis-related costs, and total costs of care were also assessed before and after the educational intervention.
RESULTS: Our survey showed that total adherence to the guideline recommendations among surgeons in our center was relatively low, and in 71.8% of procedures, at least in one of the quality indicators, non-adherence to the guideline recommendations was observed. After the educational intervention, a significant improvement in the rationality of antibiotic prophylaxis, in terms of not administrating antibiotic prophylaxis in procedures without indication, appropriate timing of administration, appropriate antibiotic dose, and appropriate duration of antibiotic prophylaxis, especially in the short time after the intervention was observed that ultimately reduced the medication, non-medication, antibiotic prophylaxis related, and total therapeutic costs.
CONCLUSIONS: Our survey showed that educational interventions provided by pharmacists in an interactive manner could improve guideline recommendations\' adherence among surgeons, particularly in a short time. Thus, continuous education still should be considered an essential element of a multifaceted intervention for improving guideline adherence.
METHODS: This prospective educational interventional study was conducted in a tertiary referral hospital for surgery in the West of Iran from September 2018 to October 2019. The study was designed in three phases: pre-intervention phase, short term after the intervention, and six months after the intervention. Within a one month course, several educational sessions regarding the appropriate preoperative antibiotic prophylaxis based on the recommendations of the American Society of Health-System Pharmacists guideline (ASHPs) were provided by a clinical pharmacist in an interactive manner for the surgeons. The appropriateness of antibiotic prophylaxis regarding the necessity for surgical antibiotic prophylaxis use (indication), the choice of antibiotic, the timing of antibiotic administration, the route of administration, the dose of antibiotics, and the total duration of antibiotic prophylaxis were evaluated and compared before and after the educational intervention. Additionally, medication-related costs, non-medication-related costs, antibiotic prophylaxis-related costs, and total costs of care were also assessed before and after the educational intervention.
RESULTS: Our survey showed that total adherence to the guideline recommendations among surgeons in our center was relatively low, and in 71.8% of procedures, at least in one of the quality indicators, non-adherence to the guideline recommendations was observed. After the educational intervention, a significant improvement in the rationality of antibiotic prophylaxis, in terms of not administrating antibiotic prophylaxis in procedures without indication, appropriate timing of administration, appropriate antibiotic dose, and appropriate duration of antibiotic prophylaxis, especially in the short time after the intervention was observed that ultimately reduced the medication, non-medication, antibiotic prophylaxis related, and total therapeutic costs.
CONCLUSIONS: Our survey showed that educational interventions provided by pharmacists in an interactive manner could improve guideline recommendations\' adherence among surgeons, particularly in a short time. Thus, continuous education still should be considered an essential element of a multifaceted intervention for improving guideline adherence.
摘要：
背景：这项研究旨在评估药剂师提供的教育计划对干预后短时间和长时间内外科抗生素预防和成本节省的适当性的影响的可持续性。
方法：这项前瞻性教育干预研究于2018年9月至2019年10月在伊朗西部的一家三级外科转诊医院进行。该研究分为三个阶段：干预前阶段，短期干预后，干预后六个月。在一个月的课程中，根据美国卫生系统药剂师协会指南(ASHP)的建议,临床药剂师以互动方式为外科医生提供了几次关于适当的术前抗生素预防的教育课程.关于外科抗生素预防使用必要性的抗生素预防的适当性（适应症），抗生素的选择，抗生素给药的时机，管理的途径,抗生素的剂量，评估和比较教育干预前后抗生素预防的总持续时间。此外,药物相关费用，非药物相关费用，抗生素预防相关费用，并在教育干预前后评估了护理总费用.
结果：我们的调查显示，我们中心的外科医生对指南建议的总依从性相对较低，在71.8%的手术中，至少在一个质量指标中，观察到不遵守指南建议.教育干预后,抗生素预防的合理性显著提高，在没有适应症的程序中不施用抗生素预防，适当的管理时机，适当的抗生素剂量，和适当的抗生素预防持续时间，特别是在干预后的短时间内，观察到最终减少了药物，非药物治疗,抗生素预防相关，和总治疗费用。
结论：我们的调查表明，药剂师以互动方式提供的教育干预措施可以提高外科医生的指南建议的依从性，特别是在短时间内。因此，继续教育仍应被视为改善指导方针依从性的多方面干预措施的基本要素。
方法：这项前瞻性教育干预研究于2018年9月至2019年10月在伊朗西部的一家三级外科转诊医院进行。该研究分为三个阶段：干预前阶段，短期干预后，干预后六个月。在一个月的课程中，根据美国卫生系统药剂师协会指南(ASHP)的建议,临床药剂师以互动方式为外科医生提供了几次关于适当的术前抗生素预防的教育课程.关于外科抗生素预防使用必要性的抗生素预防的适当性（适应症），抗生素的选择，抗生素给药的时机，管理的途径,抗生素的剂量，评估和比较教育干预前后抗生素预防的总持续时间。此外,药物相关费用，非药物相关费用，抗生素预防相关费用，并在教育干预前后评估了护理总费用.
结果：我们的调查显示，我们中心的外科医生对指南建议的总依从性相对较低，在71.8%的手术中，至少在一个质量指标中，观察到不遵守指南建议.教育干预后,抗生素预防的合理性显著提高，在没有适应症的程序中不施用抗生素预防，适当的管理时机，适当的抗生素剂量，和适当的抗生素预防持续时间，特别是在干预后的短时间内，观察到最终减少了药物，非药物治疗,抗生素预防相关，和总治疗费用。
结论：我们的调查表明，药剂师以互动方式提供的教育干预措施可以提高外科医生的指南建议的依从性，特别是在短时间内。因此，继续教育仍应被视为改善指导方针依从性的多方面干预措施的基本要素。
