Adherence to Guidelines for Antibiotic Use in Respiratory Infections at Hospitals
The purpose of this study is to test a strategy to improve the quality of antibiotic use in lower respiratory tract infections (LRTIs) at hospitals. Therefore, a multifaceted intervention strategy is compared to a control strategy and the effectiveness and feasibility of the intervention is assessed.
Behavioral: Professional education
Behavioral: Implementation of a Critical Care Pathway
Behavioral: Professional audit and feedback
Behavioral: Process analysis and redesign
|Study Design:||Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Educational/Counseling/Training
|Official Title:||Prevention of Antimicrobial Resistance in Hospitals: Promoting Appropriate Use of Antibiotics in Hospital Departments of Internal and Pulmonary Medicine|
- adherence to key quality indicators for antibiotic use in lower respiratory tract infections (indicators were developed from current [inter]national guideline recommendations and a systematic review of the literature)
- process evaluation: how well was the intervention performed
- length of hospital stay
- in-hospital mortality
- Intensive Care Unit (ICU)-transfer
- 30 day re-admission rate
|Study Start Date:||September 2002|
|Estimated Study Completion Date:||April 2005|
Improving processes of care in patients with hospital LRTI has been related to better patient outcome. Inappropriate use of antibiotics has contributed to the emergence and spread of drug-resistant micro organisms and increased treatment costs. International guidelines provide recommendations for the initial evaluation and management of LRTI, including advice on judicious antibiotic therapy. Nonetheless, studies have demonstrated a wide variability in adherence to these guidelines.
To implement key recommendations in clinical practice, various strategies have been used, with mixed results. Perhaps the most important aspect of choosing a potentially effective intervention is that the choice of intervention should be based upon assessment of potential barriers in the target group. Many intervention studies are flawed by failing to control for secular trends.
The investigators performed a cluster randomised controlled trial, to study the effect of a multifaceted intervention strategy on the quality of antibiotic use for LRTI. Their intervention was tailored to the areas most in need for improvement and took perceived barriers in the target group into consideration at the individual hospital level.
|Ziekenhuis Gelderse Vallei|
|Maxima Medisch Centrum|
|Vie Curi Medisch Centrum|
|Principal Investigator:||Marlies E Hulscher, MSc, PhD||Centre for Quality of Care Research, Radboud University Nijmegen Medical Centre|
|Study Director:||Richard P Grol, MSc, PhD||Centre for Quality of Care Research, Radboud University Nijmegen Medical Centre|
|Study Director:||Jos WM van der Meer, MD, PhD||Department of General Internal Medicine, Radboud University Nijmegen Medical Centre|