Improving Antibiotic Use in Acute Care Treatment (IMPAACT)
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Purpose
Purpose The emergence and rapid rise in antibiotic resistance among common bacteria are adversely affecting the clinical course and health care costs of community-acquired infections. Because antibiotic resistance rates are strongly correlated with antibiotic use patterns, multiple organizations have declared reductions in unnecessary antibiotic use to be critical components of efforts to combat antibiotic resistance. Among humans, the vast majority of unnecessary antibiotic prescriptions are used to treat acute respiratory tract infections (ARIs) that have a viral etiology. Although the rate of antibiotic prescribing for ARIs by office-based physicians in the US has decreased about 16% from its peak in 1997, the rate of antibiotic prescribing in acute care settings (eg, emergency departments and urgent care centers), which account for 1 in 5 ambulatory antibiotic prescriptions in the US, has shown only a modest decline (6%) during this period. Translation of lessons from intervention studies in office-based practices is needed to improve antibiotic use in acute care settings.
| Condition | Intervention |
|---|---|
|
Respiratory Infections |
Behavioral: Physician & patient education on appropriate antibiotic use Procedure: Rapid C-reactive protein testing to guide antibiotic treatment |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Factorial Assignment Masking: Open Label |
| Official Title: | Improving Antibiotic Use in Acute Care Setting |
- Proportion of all acute respiratory infection visits treated with antibiotics [ Designated as safety issue: No ]
- Delayed antibiotic treatment of acute respiratory infections; Patient satisfaction [ Designated as safety issue: No ]
| Estimated Enrollment: | 1000 |
| Study Start Date: | February 2004 |
| Study Completion Date: | July 2007 |
| Arms | Assigned Interventions |
|---|---|
| Arm 1 | Behavioral: Physician & patient education on appropriate antibiotic use Procedure: Rapid C-reactive protein testing to guide antibiotic treatment |
Detailed Description:
Objectives:
Specific Aim 1: To evaluate the impact of a multidimensional (patient, system, clinician) intervention on appropriate antibiotic use for adults with acute respiratory tract infections-- identifying factors that influence successful translation across VA hospital and non-VA hospital acute care. Specific Aim 2: To evaluate the impact of a rapid diagnostic test for c-reactive protein on antibiotic use for adults with acute cough illness when added to a multidimensional intervention.
Methods:
We propose to conduct a randomized controlled trial of a quality improvement program consisting of physician education (educational seminar, practice guidelines, performance feedback, and decision support tools) and patient education (waiting room print and audiovisual materials) in 8 VA hospital and 8 non-VA hospital emergency departments. Non VA study sites will be identified from an existing research network of hospital emergency departments--EDNet. VA hospital sites will be selected among academically affiliated hub facilities. Phase one will involve a hospital-level randomized trial of a multidimensional intervention to translate existing evidence based guidelines for antibiotic use in ARIs vs. usual care. Simultaneously, we will validate a new CRP-based diagnostic algorithm and incorporate it into the evidence based guidelines for antibiotic use in ARIs. Phase two will involve a second hospital-level randomized trial of the new antibiotic use guidelines that incorporate the CRP-based diagnostic algorithm vs. the original guidelines. Specific endpoints include the overall success of the intervention in each phase in terms of reducing antibiotic prescribing for ARIs, improving patient outcomes and reducing resource utilization. In addition we will examin the impact of VA and non-VA organizational factors on the successful translation of various components of the intervention in both phases. Data will be collected using existing administrative data as well as on-site enrollment of subjects in prospective follow-up studies.
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Emergency room patient
- Selected VA or Non-VA patients
- Age 18 years or older
- Patient must have acute respiratory illness
- Patient must not have been seen in Emergency Department within 4 weeks
Exclusion Criteria:
- Patients less than 18 years of age
- Patient in Emergency Department for non-acute respiratory infection
Contacts and Locations| United States, California | |
| VA San Diego Healthcare System, San Diego | |
| San Diego, California, United States, 92161 | |
| United States, Georgia | |
| VA Medical Center, Augusta | |
| Augusta, Georgia, United States, 30904-6285 | |
| United States, Illinois | |
| Edward Hines Jr. VA Hospital, Hines, IL | |
| Hines, Illinois, United States, 60141-5000 | |
| United States, Missouri | |
| Kansas City VA Medical Center | |
| Kansas City, Missouri, United States, 64128 | |
| United States, New Mexico | |
| New Mexico VA Health Care System | |
| Albuquerque, New Mexico, United States, 87108-5153 | |
| United States, New York | |
| James J Peters VA Medical Center | |
| Bronx, New York, United States, 10468 | |
| United States, Pennsylvania | |
| Center for Health Equity Research and Promotion | |
| Philadelphia, Pennsylvania, United States, 19104 | |
| Center for Health Equity Research and Promotion | |
| Pittsburgh, Pennsylvania, United States, 15206 | |
| United States, Texas | |
| VA South Texas Health Care System, San Antonio | |
| San Antonio, Texas, United States, 78229 | |
| Principal Investigator: | Joshua P. Metlay, MD PhD | Center for Health Equity Research and Promotion |
More Information
Additional Information:
Publications:
| Responsible Party: | Department of Veterans Affairs |
| ClinicalTrials.gov Identifier: | NCT00144040 History of Changes |
| Other Study ID Numbers: | AVA 03-239, R01 HF13915 |
| Study First Received: | August 31, 2005 |
| Last Updated: | April 18, 2013 |
| Health Authority: | United States: Federal Government |
Keywords provided by Department of Veterans Affairs:
|
Antibiotics Respiratory Infections Quality Assurance, Healthcare |
Professional Education Emergency Services, Medical Education, Patient |
Additional relevant MeSH terms:
|
Respiratory Tract Infections Infection Respiratory Tract Diseases Anti-Bacterial Agents |
Anti-Infective Agents Therapeutic Uses Pharmacologic Actions |
ClinicalTrials.gov processed this record on May 19, 2013