التفاصيل البيبلوغرافية
| العنوان: |
A pragmatic randomized trial of a primary care antimicrobial stewardship intervention in Ontario, Canada. |
| المؤلفون: |
McIsaac, Warren, Kukan, Sahana, Huszti, Ella, Szadkowski, Leah, O'Neill, Braden, Virani, Sophia, Ivers, Noah, Lall, Rosemarie, Toor, Navsheer, Shah, Mruna, Alvi, Ruby, Bhatt, Aashka, Nakamachi, Yoshiko, Morris, Andrew M. |
| المصدر: |
BMC Family Practice; 9/15/2021, Vol. 22 Issue 1, p1-8, 8p |
| مصطلحات موضوعية: |
ANTIBIOTICS, ANTIMICROBIAL stewardship, EVALUATION of medical care, RESPIRATORY diseases, CONFIDENCE intervals, URINARY tract infections, ANTI-infective agents, PRIMARY health care, RANDOMIZED controlled trials, COMPARATIVE studies, DRUGS, DESCRIPTIVE statistics, ODDS ratio |
| مصطلحات جغرافية: |
ONTARIO |
| مستخلص: |
Background: More than 90% of antibiotics are prescribed in primary care, but 50% may be unnecessary. Reducing unnecessary antibiotic overuse is needed to limit antimicrobial resistance. We conducted a pragmatic trial of a primary care provider-focused antimicrobial stewardship intervention to reduce antibiotic prescriptions in primary care. Methods: Primary care practitioners from six primary care clinics in Toronto, Ontario were assigned to intervention or control groups to evaluate the effectiveness of a multi-faceted intervention for reducing antibiotic prescriptions to adults with respiratory and urinary tract infections. The intervention included provider education, clinical decision aids, and audit and feedback of antibiotic prescribing. The primary outcome was total antibiotic prescriptions for these infections. Secondary outcomes were delayed prescriptions, prescriptions longer than 7 days, recommended antibiotic use, and outcomes for individual infections. Generalized estimating equations were used to estimate treatment effects, adjusting for clustering by clinic and baseline differences. Results: There were 1682 encounters involving 54 primary care providers from January until May 31, 2019. In intervention clinics, the odds of any antibiotic prescription was reduced 22% (adjusted Odds Ratio (OR) = 0.78; 95% Confidence Interval (CI) = 0.64.0.96). The odds that a delay in filling a prescription was recommended was increased (adjusted OR=2.29; 95% CI=1.37, 3.83), while prescription durations greater than 7 days were reduced (adjusted OR=0.24; 95% CI=0.13, 0.43). Recommended antibiotic use was similar in control (85.4%) and intervention clinics (91.8%, p=0.37). Conclusions: A community-based, primary care provider-focused antimicrobial stewardship intervention was associated with a reduced likelihood of antibiotic prescriptions for respiratory and urinary infections, an increase in delayed prescriptions, and reduced prescription durations. Trial registration: clinicaltrials.gov (NCT03517215). [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
Complementary Index |
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