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Abstract：
BACKGROUND: A study previously conducted in primary care practices found that implementation of an educational session and peer comparison feedback was associated with reduced antibiotic prescribing for respiratory tract diagnoses (RTDs). Here, we assess the long-term effects of this intervention on antibiotic prescribing following cessation of feedback.
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.
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.
摘要：
背景：先前在初级保健实践中进行的一项研究发现，实施教育会议和同伴比较反馈与减少呼吸道诊断（RTD）的抗生素处方有关。这里,我们评估了该干预措施对停止反馈后抗生素处方的长期影响.
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。
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。
