Building resources to improve treatment in two clinical priority areas – antibiotic prescribing for routine infections and treatment for frail elderly populations

Abstract Background Clinical practice guidelines (CPGs) recommend the monitoring of somatic parameters in patients treated with antipsychotic drugs in order to detect adverse effects. The objective of this study was to assess, in adult and (frail) elderly populations, the consistency and applicability of the somatic monitoring instructions recommended by established CPGs prior to and during antipsychotic drug use. Methods A search for national and international CPGs was performed by querying the electronic database PubMed and Google. Somatic monitoring instructions were assessed for adult and (frail) elderly populations separately. The applicability of somatic monitoring instructions was assessed using the Systematic Information for Monitoring (SIM) score. Somatic monitoring instructions were considered applicable when a minimum SIM score of 3 was reached. Results In total, 16 CPGs were included, with a total of 231 somatic monitoring instructions (mean: 14; range: 0–47). Of the somatic monitoring instructions, 87% were considered applicable, although critical values and how to respond to aberrant values were only present in 28 and 52% of the available instructions respectively. Only 1 CPG presented an instruction specifically for (frail) elderly populations. Conclusions We emphasize the need for a guideline with somatic monitoring instructions based on the SIM definition for both adult and (frail) elderly populations using antipsychotic drugs. In addition, CPGs should state that clear agreements should be made regarding who is responsible for interventions and somatic monitoring prior to and during antipsychotic drug use.

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Multifaceted antibiotic stewardship intervention using a participatory-action-research approach to improve antibiotic prescribing for urinary tract infections in frail elderly (ImpresU): study protocol for a European qualitative study followed by a pragmatic cluster randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2021-052552 ◽

2021 ◽

Vol 11 (10) ◽

pp. e052552

Author(s):

Esther A R Hartman ◽

Wim G Groen ◽

Silje Rebekka Heltveit-Olsen ◽

Morten Lindbaek ◽

Sigurd Hoye ◽

...

Keyword(s):

Qualitative Study ◽

Frail Elderly ◽

Controlled Trial ◽

Elderly Care ◽

Cluster Randomised Controlled Trial ◽

Antibiotic Use ◽

Research Approach ◽

Antibiotic Prescribing ◽

Action Research Approach ◽

Tract Infections

IntroductionAlmost 60% of antibiotics in frail elderly are prescribed for alleged urinary tract infections (UTIs). A substantial part of this comprises prescriptions in case of non-specific symptoms or asymptomatic bacteriuria, for which the latest guidelines promote restrictiveness with antibiotics. We aim to reduce inappropriate antibiotic use for UTIs through an antibiotic stewardship intervention (ASI) that encourages to prescribe according to these guidelines. To develop an effective ASI, we first need a better understanding of the complex decision-making process concerning suspected UTIs in frail elderly. Moreover, the implementation approach requires tailoring to the heterogeneous elderly care setting.Methods and analysisFirst, we conduct a qualitative study to explore factors contributing to antibiotic prescribing for UTIs in frail elderly, using semi-structured interviews with general practitioners, nursing staff, patients and informal caregivers. Next, we perform a pragmatic cluster randomised controlled trial in elderly care organisations. A multifaceted ASI is implemented in the intervention group; the control group receives care as usual. The ASI is centred around a decision tool that promotes restrictive antibiotic use, supported by a toolbox with educational materials. For the implementation, we use a modified participatory-action-research approach, guided by the results of the qualitative study. The primary outcome is the number of antibiotic prescriptions for suspected UTIs. We aim to recruit 34 clusters with in total 680 frail elderly residents ≥70 years. Data collection takes place during a 5-month baseline period and a 7-month follow-up period. Finally, we perform a process evaluation. The study has been delayed for 6 months due to COVID-19 and is expected to end in July 2021.Ethics and disseminationEthical approvals and/or waivers were obtained from the ethical committees in Poland, the Netherlands, Norway and Sweden. The results will be disseminated through publication in peer-reviewed journals and conference presentations.Trial registration numberNCT03970356.

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A Multi-focus Assessment Scale for Use With Frail Elderly Populations

Canadian Journal on Aging / La Revue canadienne du vieillissement ◽

10.1017/s0714980800015919 ◽

1985 ◽

Vol 4 (2) ◽

pp. 101-109 ◽

Cited By ~ 12

Author(s):

M. Coval ◽

D. Crockett ◽

S. Holliday ◽

W. Koch

Keyword(s):

Elderly Patient ◽

Psychometric Properties ◽

Frail Elderly ◽

Psychological Assessment ◽

Test Scores ◽

Interrater Reliability ◽

Full Range ◽

Cognitive Status ◽

Assessment Instrument ◽

Elderly Populations

ABSTRACTThis paper reports the development of a psychological assessment instrument for evaluating the deteriorated elderly patient. The instrument provides information on patient function in eight areas including communication abilities, cognitive status and mood. Analyses were undertaken to determine the psychometric properties of each component of the instrument. Examination of the means and standard deviations indicated that the full range was used for each scale. Examination of interrater reliability yielded values ranging from .92 to .99. Several indices that may be of use in evaluating the significance of change in test scores are also presented. Suggestions are also made for the application of this instrument in both clinical and research settings.

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