scholarly journals Proxy indicators to estimate the appropriateness of medications prescribed by paediatricians in infectious diseases: a cross-sectional observational study based on reimbursement data

2020 ◽  
Vol 2 (4) ◽  
Author(s):  
N Thilly ◽  
O Pereira ◽  
J Schouten ◽  
M E J L Hulscher ◽  
C Pulcini
Keyword(s):  
Observational Study ◽  
Infectious Diseases ◽  
Antibiotic Use ◽  
Paediatric Population ◽  
Health Insurance Data ◽  
Cross Sectional ◽  
Improvement Potential ◽  
North Eastern ◽  
Reimbursement Database ◽  
Proxy Indicators

Abstract Background We previously developed proxy indicators (PIs) that can be used to estimate the appropriateness of medications used for infectious diseases (in particular antibiotics) in primary care, based on routine reimbursement data that do not include clinical indications. Objectives To: (i) select the PIs that are relevant for children and estimate current appropriateness of medications used for infectious diseases by French paediatricians and its variability while using these PIs; (ii) assess the clinimetric properties of these PIs using a large regional reimbursement database; and (iii) compare performance scores for each PI between paediatricians and GPs in the paediatric population. Methods For all individuals living in north-eastern France, a cross-sectional observational study was performed analysing National Health Insurance data (available at prescriber and patient levels) regarding antibiotics prescribed by their paediatricians in 2017. We measured performance scores of the PIs, and we tested their clinimetric properties, i.e. measurability, applicability and room for improvement. Results We included 116 paediatricians who prescribed a total of 44 146 antibiotic treatments in 2017. For all four selected PIs (seasonal variation of total antibiotic use, amoxicillin/second-line antibiotics ratio, co-prescription of anti-inflammatory drugs and antibiotics), we found large variations between paediatricians. Regarding clinimetric properties, all PIs were measurable and applicable, and showed high improvement potential. Performance scores did not differ between these 116 paediatricians and 3087 GPs. Conclusions This set of four proxy indicators might be used to estimate appropriateness of prescribing in children in an automated way within antibiotic stewardship programmes.

Quantity Metrics and Proxy Indicators to Estimate the Volume and Appropriateness of Antibiotics Prescribed in French Nursing Homes: A Cross-sectional Observational Study Based on 2018 Reimbursement Data

2020 ◽  
Author(s):  
Maïa Simon ◽  
Ouarda Pereira ◽  
Marlies E J L Hulscher ◽  
Jeroen Schouten ◽  
Nathalie Thilly ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Observational Study ◽  
Antibiotic Stewardship ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Community Based ◽  
Cross Sectional ◽  
Home Context ◽  
Northeastern France ◽  
Proxy Indicators

Abstract Background Antibiotic resistance is an increasing threat to public health globally. Indicators on antibiotic prescribing are required to guide antibiotic stewardship interventions in nursing homes. However, such indicators are not available in the literature. Our main objective was to provide a set of quantity metrics and proxy indicators to estimate the volume and appropriateness of antibiotic use in nursing homes. Methods Recently published articles were first used to select quantity metrics and proxy indicators, which were adapted to the French nursing home context. A cross-sectional observational study was then conducted based on reimbursement databases. We included all community-based nursing homes of the Lorraine region in northeastern France. We present descriptive statistics for quantity metrics and proxy indicators. For proxy indicators, we also assessed performance scores, clinimetric properties (measurability, applicability, and room for improvement), and conducted case-mix and cluster analyses. Results A total of 209 nursing homes were included. We selected 15 quantity metrics and 11 proxy indicators of antibiotic use. The volume of antibiotic use varied greatly between nursing homes. Proxy indicator performance scores were low, and variability between nursing homes was high for all indicators, highlighting important room for improvement. Six of the 11 proxy indicators had good clinimetric properties. Three distinct clusters were identified according to the number of proxy indicators for which the acceptable target was reached. Conclusions This set of 15 quantity metrics and 11 proxy indicators may be adapted to other contexts and could be used to guide antibiotic stewardship programs in nursing homes.

scholarly journals Proxy indicators to estimate appropriateness of antibiotic prescriptions by general practitioners: a proof-of-concept cross-sectional study based on reimbursement data, north-eastern France 2017

2020 ◽  
Vol 25 (27) ◽  
Author(s):  
Nathalie Thilly ◽  
Ouarda Pereira ◽  
Jeroen Schouten ◽  
Marlies EJL Hulscher ◽  
Céline Pulcini
Keyword(s):  
Antibiotic Use ◽  
Cross Sectional Study ◽  
Case Mix ◽  
Antibiotic Prescribing ◽  
Sectional Study ◽  
National Guidelines ◽  
Cross Sectional ◽  
Starting Point ◽  
North Eastern ◽  
Proxy Indicators

Background In most countries, including France, data on clinical indications for outpatient antibiotic prescriptions are not available, making it impossible to assess appropriateness of antibiotic use at prescription level. Aim Our objectives were to: (i) propose proxy indicators (PIs) to estimate appropriateness of antibiotic use at general practitioner (GP) level based on routine reimbursement data; and (ii) assess PIs’ performance scores and their clinimetric properties using a large regional reimbursement database. Methods A recent systematic literature review on quality indicators was the starting point for defining a set of PIs, taking French national guidelines into account. We performed a cross-sectional study analysing National Health Insurance data (available at prescriber and patient levels) on antibiotics prescribed by GPs in 2017 for individuals living in north-eastern France. We measured performance scores of the PIs and their case-mix stability, and tested their measurability, applicability, and room for improvement (clinimetric properties). Results The 3,087 GPs included in this study prescribed a total of 2,077,249 antibiotic treatments. We defined 10 PIs with specific numerators, denominators and targets. Performance was low for almost all indicators ranging from 9% to 75%, with values < 30% for eight of 10 indicators. For all PIs, we found large variation between GPs and patient populations (case-mix stability). Regarding clinimetric properties, all PIs were measurable, applicable, and showed high improvement potential. Conclusions The set of 10 PIs showed satisfactory clinimetric properties and might be used to estimate appropriateness of antibiotic prescribing in primary care, in an automated way within antibiotic stewardship programmes.

scholarly journals Design of proxy indicators estimating the appropriateness of antibiotics prescribed by French dentists: a cross-sectional study based on reimbursement data

2021 ◽  
Author(s):  
Maïa Simon ◽  
Ouarda Pereira ◽  
Julie Guillet-Thibault ◽  
Marlies E. J. L. Hulscher ◽  
Céline Pulcini ◽  
...  
Keyword(s):  
Dental Care ◽  
Cross Sectional Study ◽  
Case Mix ◽  
Antibiotic Prescribing ◽  
Health Insurance Data ◽  
Cross Sectional ◽  
Dental Practitioners ◽  
North Eastern ◽  
Proxy Indicators ◽  
Insurance Data

Background – The literature shows that the prescription of antibiotics in dental care is often unnecessary or inappropriate. Indicators estimating the appropriateness of antibiotics prescribed by dentists based on routine databases are however not available in the literature. Our objectives were to: (i) design proxy indicators estimating the appropriateness of antibiotics prescribed by dentists; (ii) evaluate their clinimetric properties; and (iii) provide results for these proxy indicators for dentists located in a north-eastern French region. Methods – We selected and adapted proxy indicators from the literature. Using 2019 Regional Health Insurance data, we evaluated the proxy indicators’ clinimetric properties (measurability, applicability, and potential room for improvement), their results with performance scores (% of dentists who reached the target value), and the case-mix stability. Results – We included 3,014 general dental practitioners, who prescribed a total of 373,975 antibiotics to 308,123 patients in 2019. We identified four proxy indicators estimating antibiotic prescribing appropriateness in dental care. All proxy indicators had good clinimetric properties. Performance scores were generally low (10.5 to 73.0%, depending on the indicator), suggesting an important room for improvement. These results showed large variations between dentists (large interquartile ranges) and according to the patients’ characteristics (case-mix stability). Conclusion – These four proxy indicators might be used to guide antibiotic stewardship interventions in dental care.

scholarly journals Correlation of Knowledge and Beliefs to Adherence with Antibiotic Use in Adult Patients at a Private Hospital in Sidoarjo

2020 ◽  
Vol 15 (2) ◽  
Author(s):  
Muhammad Hasan Wattiheluw ◽  
Fauna Herawati ◽  
Setiasih Setiasih ◽  
Rika Yulia
Keyword(s):  
Infectious Diseases ◽  
Antibiotic Therapy ◽  
Private Hospital ◽  
Antibiotic Use ◽  
Cross Sectional Study ◽  
P Value ◽  
Cross Sectional ◽  
Knowledge And Beliefs ◽  
Study Results ◽  
Hospitalization Period

Infectious diseases are one of the top ten causes of death in the world. Antibiotic therapy is administered for infectious diseases, but if bacteria are exposed to antibiotics continuously, then the bacteria are able to adapt to the medication, thereby resulting in antibiotic resistance. This condition results in an increase in mortality, long hospitalization period, and increased cost of antibiotic therapy and health services. Adherence to using antibiotics may be influenced by knowledge and beliefs about them. This study aimed to understand correlation between knowledge and belief with adherence to antibiotic use at a private hospital in Sidoarjo. This cross-sectional study, the data collected in three months period, was conducted with a questionnaire for assessment knowledge and belief. A pill count method was applied for assessment adherence to using antibiotics prescribed by doctors. The study results show that knowledge of the respondents was adequate for 76 people (69.7%), belief was adequate for 74 people (67.9%), and adherence to antibiotic use for 79 people (72%). Regression analysis showed that the variable that significantly influenced the adherence of patients in using antibiotics was perceived threat (p-value = 0,029). Sex, age, education, income, occupation, and marital status have no contribution to antibiotic knowledge, belief, and adherence.

scholarly journals Gambaran Tingkat Pengetahuan Ibu Tentang Imunisasi Vaksin Measles Rubella (MR) di UPT Blud Puskesmas Gunungsari Periode Agustus 2019

2020 ◽  
Vol 1 (1) ◽  
pp. 28
Author(s):  
Yuli Fitriana ◽  
Nur Furqani ◽  
Siti Maryam Ulfa
Keyword(s):  
Observational Study ◽  
Infectious Diseases ◽  
Primary Data ◽  
Knowledge Level ◽  
Rubella Vaccine ◽  
Cross Sectional ◽  
Purposive Sampling ◽  
Level Of Knowledge

ABSTRAKCampak dan Rubella merupakan penyakit infeksi menular melalui saluran nafas yang disebabkan oleh virus Campak dan Rubella.Batuk dan bersin dapat menjadi jalur masuknya virus campak maupun rubella. Pengetahuan vaksin  MR adalah kombinasi vaksin Campak/Measles (M) dan Rubella (R) untuk perlindungan terhadap kedua penyakit tersebut Campak dan rubella merupakan jenis penyakit yang tidak dapat di obati (virus penyebab penyakit tidak dapat dibunuh), maka imunisasi MR ini adalah pencegahan terbaik bagi keduanya. Tujuan penelitian untuk mengetahui  gambaran tingkat pengetahuan ibu tentang imunisasi vaksin measles rubella (MR) di UPT BLUD puskesmas gunungsari periode 2019. Penelitian ini merupakan penelitian observasional deskriptif dengan mengambil data secara cross sectional, populasi sebanyak 458, diperoleh sampel sebanyak 82 responden yang dipilih secara purposive sampling mengunakan data primer. Hasil penelitian menunjukkan bahwa gambaran tingkat pengetahuan ibu tentang imunisasi vaksin measles rubella yaitu 58,8%. Kata kunci :Tingkat Pengetahuan; Imunisasi; Masles Rubella ; Puskesmas. ABSTRACTMeasles and Rubella are infectious diseases transmitted through the airways caused by the Measles and Rubella viruses. Coughing and sneezing can be a pathway for measles and rubella viruses. Knowledge MR vaccine is a combination of  Measles (M) and Rubella (R) vaccines for protection against both The disease Measles and rubella are types of diseases that can not be treated (the virus that causes the disease can not be killed), then MR  immunization is the best prevention for both. The purpose of this research is to find out the description of mothers' knowledge about  immunization Measles Rubella (MR) vaccine in UPT BLUD puskesmas gunungsari period 2019. This research is a descriptive observational study by taking cross sectional data, a population of 458, obtained a sample of 82 respondents selected by purposive sampling using primary data. The results showed that the level of knowledge of mothers about measles rubella vaccine immunization was 58.8%. Keywords : Knowledge Level; Immunization; Masles Rubella ; Puskesmas 

scholarly journals Assessment of Antibiotic use in Pregnant Women in a Tertiary care Teaching Hospital – A Cross Sectional Observational Study

2021 ◽  
Vol 9 (8) ◽  
Keyword(s):  
Urinary Tract ◽  
Observational Study ◽  
Pregnant Women ◽  
Urinary Tract Infections ◽  
Teaching Hospital ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Cross Sectional ◽  
Tertiary Care Teaching Hospital ◽  
Tract Infections

During pregnancy, most women are at risk for respiratory tract infections (RTIs), urinary tract infections (UTIs), and ear, nose, and throat infections. Antimicrobials are the most commonly given medications to treat acquired illnesses during this time. This study aimed to assess antibiotic use in pregnant women in a tertiary care teaching hospital. The present study was a cross- sectional prospective observational study and was conducted for three months in a tertiary care health centre in North Karnataka with 57 participants.All case records of pregnant women who use antibiotics admitted to Obstetrics and Gynecology department and pregnant women with more than 18 years of age were included in the study. Out of 57 participants, 40.3% of them were belonging to the age category of 19-23 years of age, followed by 33.3% in 24-28 years. Most prevalent infections which required antimicrobials prescription were UTIs (36.82%), followed by Gastroenteritis (17.54%) and Pyrexia (14.03%). Majority of the antimicrobials prescribed were from Betalactams (40.34%), followed by Nitrofuranes (29.82%). To assist in making prescribing decisions for pregnant women, health care professionals should examine the teratogenic and toxic risk profiles of antibiotics. These could be especially significant if anti- infective countermeasures are needed to safeguard the health, safety, and survival of people who have been exposed to pathogenic bacteriologic agents as a result of bioterrorism. Keywords: Antimicrobials, pregnancy, teratogenic effect, urinary tract infections

scholarly journals Knowledge, Attitude and Practice of Community Pharmacists Regarding Antibiotic Use and Infectious Diseases: A Cross-Sectional Survey in Hungary (KAPPhA-HU)

Antibiotics ◽  
2020 ◽  
Vol 9 (2) ◽  
pp. 41 ◽  
Author(s):  
Márió Gajdács ◽  
Edit Paulik ◽  
Andrea Szabó
Keyword(s):  
Infectious Diseases ◽  
Community Pharmacists ◽  
Antibiotic Use ◽  
Health Impact ◽  
Educational Strategies ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
The Public ◽  
Attitude And Practice ◽  
Knowledge Attitude And Practice

One of the key drivers for the emergence and spread of antimicrobial resistance (AMR) is non-prudent antibiotic (AB) use, which results in selection pressure towards relevant bacteria. Community pharmacists have pivotal roles in facilitating the prudent use of ABs that have been demonstrated by several studies worldwide. The aim of our present study was to evaluate the knowledge, attitude and practice of community pharmacists related to AB use and infectious diseases in Hungary. A descriptive cross-sectional survey was performed among community pharmacists in Hungary with the use of an anonymous, structured and pilot-tested questionnaire. Data collection ran between January 2016 and January 2018; n = 339 community pharmacists nationwide were approached with our questionnaire, out of which 192 filled out our survey. Hungarian pharmacists have appropriate knowledge regarding ABs and antimicrobial therapy, and they realize the public health impact of the growing AMR. Twenty-five percent of participants admitted to giving out non-prescription ABs at least once in the last year. The age and presence of board-certified specializations were shown to be significant factors of self-perceived knowledge and professional attitudes. Educational strategies and interventions specifically aimed at focusing on identified shortcomings and changing certain attitudes could substantially improve AB dispensing and AB use, in addition to minimizing resistance.

scholarly journals Distribution of Critical Drought Areas with The Incidence of Diarrhea in East Java 2017

2019 ◽  
Vol 7 (1) ◽  
pp. 60
Author(s):  
Firdha Rizkhy Asedha
Keyword(s):  
Climate Change ◽  
Observational Study ◽  
Infectious Diseases ◽  
Indirect Effects ◽  
Meteorological Factors ◽  
Direct Effects ◽  
Cross Sectional ◽  
Contaminated Food ◽  
Study Sites ◽  
Research Period

Background: One of the factors of drought is meteorological factors, namely the influence of climate. There are two effects caused by erratic climate change namely direct effects and indirect effects. The indirect effects of which are related to infectious diseases, such as diarrhea diseases which are caused by the transmission of contaminated food and water, while water itself is closely related to drought. Purpose: This study aims to describe the distribution of critical drought areas with the incidence of diarrhea in East Java 2017. Methods: This research is a descriptive observational study with cross sectional research design. The population and samples were all patients with diarrhea and critical drought areas in East Java Province in 2017. The study sites were in East Java Province with the research period in August-October 2018. The variables studied were drought with the incidence of diarrhea. Results: The percentage of the highest critical drought areas in East Java 2017 was Sampang Regency (23%) followed by Trenggalek Regency (22%) and there were 15 Regencies/ Cities that did not experience critical drought in East Java 2017. While the incidence of diseases diarrhea in East Java 2017 was the highest in Sidoarjo Regency (65,543 cases) followed by Mojokerto Regency (64,468 cases), and the lowest incidence of diarrhea was in Probolinggo City (254 cases). Conclusion: Distribution of critical drought areas does not affect the incidence of diarrhea in East Java 2017.

scholarly journals Assessment of clinicopathological parameters and outcome of critically ill patients admitted with infectious endemic diseases in a rural tertiary setup of India - An observational study

2020 ◽  
Vol 16 (1) ◽  
pp. 45-52
Author(s):  
Anuja P Makan ◽  
Keyword(s):  
Renal Failure ◽  
Intensive Care ◽  
Observational Study ◽  
Infectious Diseases ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinicopathological Parameters ◽  
Cross Sectional ◽  
Endemic Diseases ◽  
Co Morbidity

Background: To study the clinico-pathological profile and outcome of critically ill patients with infectious endemic diseases requiring intensive care management Methods: A prospective, non randomized, cross sectional, observational study of 50 critically ill patients (more than 18 years of age) admitted in the ICU setup in a rural tertiary hospital over 2 years, suffering from an endemic tropical disease, was conducted. Parameters to study the outcome of the study were indication for ICU management, evidence of multiple system involvement, common precipitating factor and associated morbidity and mortality. Findings: Our study regarding endemic infectious diseases of Western Maharashtra included 15 females (30%) and 35 males (70%). The mean age in our study was 40.52 ± 15.08 years with minimum of 19 years and maximum of 63 years. Fever (n=50) followed by jaundice (n=19) and renal failure were the most common presenting features. A qSOFA Score of 2 and 3 were common on presentation (n=23). Mean SOFA score at presentation for patients admitted in the ICU for management of endemic infectious diseases was 13.6 ± 5.3. Most common co morbidity seen was diabetes (n=10) followed by thyroid disorders (n=5) and chronic Liver Disease (n=3). Mortality in our study was 12 patients (24%). Results: It has been seen that higher SOFA scores at 24 hours of presentation led to longer duration of hospital stay. Most common organ failure was renal failure in 29 patients (28%) followed by hepatic failure in 17 patients (34%) during the course of ICU stay. Conclusion: qSOFA scores of 2 or above at the time of hospitalisation was an important predictor of mortality. Understanding the features and complications of endemic infectious diseases help to identify patients at high risk and treat them with optimal intensive care.

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