METHODS: RTD encounters were grouped into tiers based on antibiotic prescribing appropriateness: tier 1, almost always indicated; tier 2, possibly indicated; and tier 3, rarely indicated. A χ2 test was used to compare prescribing between 3 time periods: pre-intervention, intervention, and post-intervention (14 months following cessation of feedback). A mixed-effects multivariable logistic regression analysis was performed to assess the association between period and prescribing.
RESULTS: We analyzed 260 900 RTD encounters from 29 practices. Antibiotic prescribing was more frequent in the post-intervention period than in the intervention period (28.9% vs 23.0%, P < .001) but remained lower than the 35.2% pre-intervention rate (P < .001). In multivariable analysis, the odds of prescribing were higher in the post-intervention period than the intervention period for tier 2 (odds ratio [OR], 1.19; 95% confidence interval [CI]: 1.10-1.30; P < .05) and tier 3 (OR, 1.20; 95% CI: 1.12-1.30) indications but was lower compared to the pre-intervention period for each tier (OR, 0.66; 95% CI: 0.59-0.73 tier 2; OR, 0.68; 95% CI: 0.61-0.75 tier 3).
CONCLUSIONS: The intervention effects appeared to last beyond the intervention period. However, without ongoing provider feedback, there was a trend toward increased prescribing. Future studies are needed to determine optimal strategies to sustain intervention effects.
方法:根据抗生素处方的适当性将RTD遇到分为几层:第1层,几乎总是指示;第2层,可能指示;第3层,很少指示。使用χ2检验比较3个时间段之间的处方:干预前,干预,和干预后(停止反馈后14个月)。进行了混合效应多变量逻辑回归分析,以评估周期和处方之间的关联。
结果:我们分析了来自29个实践的260900RTD遭遇。抗生素处方在干预后期间比干预期间更频繁(28.9%vs23.0%,P<.001),但仍低于干预前的35.2%(P<.001)。在多变量分析中,干预后的处方几率高于第2级的干预期(比值比[OR],1.19;95%置信区间[CI]:1.10-1.30;P<.05)和第3层(OR,1.20;95%CI:1.12-1.30)适应症,但与每一层的干预前相比较低(OR,0.66;95%CI:0.59-0.73二级;或,0.68;95%CI:0.61-0.75三级)。
结论:干预效果似乎持续超过干预期。然而,如果没有提供商的持续反馈,有增加处方的趋势。未来的研究需要确定维持干预效果的最佳策略。