PDF(Pubmed)
Abstract：
Tools to advance antimicrobial stewardship in the primary health care setting, where most antimicrobials are prescribed, are urgently needed. The aim of this study was to evaluate OPEN Stewarship (Online Platform for Expanding aNtibiotic Stewardship), an automated feedback intervention, among a cohort of primary care physicians. We performed a controlled, interrupted time-series study of 32 intervention and 725 control participants, consisting of primary care physicians from Ontario, Canada and Southern Israel, from October 2020 to December 2021. Intervention participants received three personalized feedback reports targeting several aspects of antibiotic prescribing. Study outcomes (overall prescribing rate, prescribing rate for viral respiratory conditions, prescribing rate for acute sinusitis, and mean duration of therapy) were evaluated using multilevel regression models. We observed a decrease in the mean duration of antibiotic therapy (IRR = 0.94; 95% CI: 0.90, 0.99) in intervention participants during the intervention period. We did not observe a significant decline in overall antibiotic prescribing (OR = 1.01; 95% CI: 0.94, 1.07), prescribing for viral respiratory conditions (OR = 0.87; 95% CI: 0.73, 1.03), or prescribing for acute sinusitis (OR = 0.85; 95% CI: 0.67, 1.07). In this antimicrobial stewardship intervention among primary care physicians, we observed shorter durations of therapy per antibiotic prescription during the intervention period. The COVID-19 pandemic may have hampered recruitment; a dramatic reduction in antibiotic prescribing rates in the months before our intervention may have made physicians less amenable to further reductions in prescribing, limiting the generalizability of the estimates obtained.IMPORTANCEAntibiotic overprescribing contributes to antibiotic resistance, a major threat to our ability to treat infections. We developed the OPEN Stewardship (Online Platform for Expanding aNtibiotic Stewardship) platform to provide automated feedback on antibiotic prescribing in primary care, where most antibiotics for human use are prescribed but where the resources to improve antibiotic prescribing are limited. We evaluated the platform among a cohort of primary care physicians from Ontario, Canada and Southern Israel from October 2020 to December 2021. The results showed that physicians who received personalized feedback reports prescribed shorter courses of antibiotics compared to controls, although they did not write fewer antibiotic prescriptions. While the COVID-19 pandemic presented logistical and analytical challenges, our study suggests that our intervention meaningfully improved an important aspect of antibiotic prescribing. The OPEN Stewardship platform stands as an automated, scalable intervention for improving antibiotic prescribing in primary care, where needs are diverse and technical capacity is limited.
摘要：
在初级卫生保健环境中推进抗菌药物管理的工具，大多数抗生素都是开处方的，迫切需要。这项研究的目的是评估OPENStewarship（扩大抗生素管理的在线平台），自动反馈干预，在一群初级保健医生中。我们表演了一个受控的，32名干预和725名对照参与者的中断时间序列研究，由安大略省的初级保健医生组成，加拿大和以色列南部，从2020年10月到2021年12月。干预参与者收到了三份针对抗生素处方几个方面的个性化反馈报告。研究结果(总体处方率，病毒呼吸道疾病的处方率，急性鼻窦炎的处方率，和平均治疗持续时间）使用多水平回归模型进行评估。我们观察到干预期间干预参与者的抗生素治疗平均持续时间减少（IRR=0.94；95％CI：0.90，0.99）。我们没有观察到总体抗生素处方的显着下降（OR=1.01;95％CI：0.94，1.07），病毒性呼吸道疾病的处方（OR=0.87；95%CI：0.73，1.03），或急性鼻窦炎的处方（OR=0.85；95％CI：0.67，1.07）。在初级保健医生的抗菌药物管理干预中，我们观察到干预期间每个抗生素处方的治疗持续时间较短.COVID-19大流行可能阻碍了招聘；在我们干预之前的几个月里，抗生素处方率大幅下降，可能使医生不太愿意进一步减少处方，限制了所获得估计的概括性。IMPORTANCEAntiopicoverdeclaringcontributestoantironeresistance,对我们治疗感染能力的重大威胁。我们开发了OPEN管理（扩大抗生素管理的在线平台）平台，以提供有关初级保健中抗生素处方的自动反馈，大多数人类使用的抗生素都是处方，但改善抗生素处方的资源有限。我们在一群来自安大略省的初级保健医生中评估了这个平台，加拿大和以色列南部，从2020年10月到2021年12月。结果显示，与对照组相比，接受个性化反馈报告的医生开出的抗生素疗程较短，尽管他们没有写出更少的抗生素处方。虽然COVID-19大流行带来了后勤和分析挑战，我们的研究表明,我们的干预有意义地改善了抗生素处方的一个重要方面.OPEN管理平台是一个自动化的，可扩展的干预措施，以改善初级保健中的抗生素处方，需求多样，技术能力有限。
