Privacy-preserving audit and feedback on the antibiotic prescribing of General Practitioners (Preprint)

2021 ◽  
Author(s):  
Kassaye Yitbarek Yigzaw ◽  
Taridzo Chomutare ◽  
Rolf Wynn ◽  
Gro Karine Rosvold Berntsen ◽  
Johan Gustav Bellika
Keyword(s):  
General Practitioners ◽  
Clinical Performance ◽  
Inappropriate Prescribing ◽  
Public Health Problem ◽  
Privacy Preserving ◽  
Audit And Feedback ◽  
Antibiotic Prescribing ◽  
Clinical Settings ◽  
Tract Infections ◽  
F System

BACKGROUND Antibiotic resistance is a worldwide public health problem that is accelerated by misuse and overuse of antibiotics. Studies have shown that audit and feedback enabling clinicians to compare their clinical performance with their peers is effective in reducing inappropriate prescribing of antibiotics. However, privacy concerns make the audit and feedback hard to implement in clinical settings. Therefore, we have developed a privacy-preserving audit and feedback (A&F). OBJECTIVE The paper aims to evaluate the privacy-preserving audit and feedback (A&F) system in clinical settings. METHODS A privacy-preserving A&F system was deployed in three primary care practices in Norway to generate feedback to twenty General Practitioners (GPs) on their prescribing of antibiotics for selected respiratory tract infections. The GPs were asked to participate in a survey shortly after using the system, and we analysed the data. RESULTS Fourteen GPs responded to the questionnaire, representing a 70% (14/20) response rate. The participants were generally satisfied with usefulness of the feedback and the comparison with peers, as well as protection of privacy. The majority of the GPs value the protection of their own privacy, as well as that of their patients. CONCLUSIONS The system overcomes important privacy and scaling challenges commonly associated with secondary use of electronic health record (EHR) data, and has a potential to improve antibiotic prescribing behaviour; however, further study is required to assess its actual effect.

scholarly journals Development of an Electronic Algorithm to Identify Inappropriate Antibiotic Prescribing for Pediatric Pharyngitis

2020 ◽  
Vol 41 (S1) ◽  
pp. s188-s189
Author(s):  
Jeffrey Gerber ◽  
Robert Grundmeier ◽  
Keith Hamilton ◽  
Lauri Hicks ◽  
Melinda Neuhauser ◽  
...  
Keyword(s):  
Predictive Value ◽  
Gold Standard ◽  
Antibiotic Stewardship ◽  
Chart Review ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Tract Infections ◽  
The Impact

Background: Antibiotic overuse contributes to antibiotic resistance and unnecessary adverse drug effects. Antibiotic stewardship interventions have primarily focused on acute-care settings. Most antibiotic use, however, occurs in outpatients with acute respiratory tract infections such as pharyngitis. The electronic health record (EHR) might provide an effective and efficient tool for outpatient antibiotic stewardship. We aimed to develop and validate an electronic algorithm to identify inappropriate antibiotic use for pediatric outpatients with pharyngitis. Methods: This study was conducted within the Children’s Hospital of Philadelphia (CHOP) Care Network, including 31 pediatric primary care practices and 3 urgent care centers with a shared EHR serving >250,000 children. We used International Classification of Diseases, Tenth Revision (ICD-10) codes to identify encounters for pharyngitis at any CHOP practice from March 15, 2017, to March 14, 2018, excluding those with concurrent infections (eg, otitis media, sinusitis), immunocompromising conditions, or other comorbidities that might influence the need for antibiotics. We randomly selected 450 features for detailed chart abstraction assessing patient demographics as well as practice and prescriber characteristics. Appropriateness of antibiotic use based on chart review served as the gold standard for evaluating the electronic algorithm. Criteria for appropriate use included streptococcal testing, use of penicillin or amoxicillin (absent β-lactam allergy), and a 10-day duration of therapy. Results: In 450 patients, the median age was 8.4 years (IQR, 5.5–9.0) and 54% were women. On chart review, 149 patients (33%) received an antibiotic, of whom 126 had a positive rapid strep result. Thus, based on chart review, 23 subjects (5%) diagnosed with pharyngitis received antibiotics inappropriately. Amoxicillin or penicillin was prescribed for 100 of the 126 children (79%) with a positive rapid strep test. Of the 126 children with a positive test, 114 (90%) received the correct antibiotic: amoxicillin, penicillin, or an appropriate alternative antibiotic due to b-lactam allergy. Duration of treatment was correct for all 126 children. Using the electronic algorithm, the proportion of inappropriate prescribing was 28 of 450 (6%). The test characteristics of the electronic algorithm (compared to gold standard chart review) for identification of inappropriate antibiotic prescribing were sensitivity (99%, 422 of 427); specificity (100%, 23 of 23); positive predictive value (82%, 23 of 28); and negative predictive value (100%, 422 of 422). Conclusions: For children with pharyngitis, an electronic algorithm for identification of inappropriate antibiotic prescribing is highly accurate. Future work should validate this approach in other settings and develop and evaluate the impact of an audit and feedback intervention based on this tool.Funding: NoneDisclosures: None

Evaluation of clinicians’ knowledge, attitudes, and planned behaviors related to an intervention to improve acute respiratory infection management

2020 ◽  
Vol 41 (6) ◽  
pp. 672-679 ◽  
Author(s):  
Hayli R. Hruza ◽  
Tania Velasquez ◽  
Karl J. Madaras-Kelly ◽  
Katherine E. Fleming-Dutra ◽  
Matthew H. Samore ◽  
...  
Keyword(s):  
Communication Strategies ◽  
Implementation Strategies ◽  
Patient Communication ◽  
Audit And Feedback ◽  
Antibiotic Prescribing ◽  
Health Administration ◽  
Prescribing Practices ◽  
Diagnostic Uncertainty ◽  
Appropriate Prescribing ◽  
Tract Infections

AbstractBackground:Acute respiratory tract infections (ARIs) are commonly diagnosed and major drivers of antibiotic prescribing. Clinician-focused interventions can reduce unnecessary antibiotic prescribing for ARIs. We elicited clinician feedback to design sustainable interventions to improve ARI management by understanding the mental framework of clinicians surrounding antibiotic prescribing within Veterans’ Health Administration clinics.Methods:We conducted one-on-one interviews with clinicians (n = 20) from clinics targeted for intervention at 5 facilities. The theory of planned behavior guided interview questions. Interviews were audio recorded and transcribed for qualitative analysis. An iterative coding approach identified 6 themes.Results:Emergent themes: (1) barriers to appropriate prescribing are multifactorial and include challenges of behavior change; (2) antibiotic prescribing decisions are perceived as autonomous yet, diagnostic uncertainty and perceptions of patient demand can make prescribing decisions difficult; (3) clinicians perceive variation in peer prescribing practices and influences; (4) clinician-focused interventions are valuable if delivered with sensitivity; (5) communication strategies for educating patients are preferred to a shared decisions process; and (6) team standardization of practice and communication are key to facilitate appropriate prescribing. Clinicians perceived audit-and-feedback with peer comparison, academic detailing, and enhanced patient communication strategies as viable approaches to improving appropriate prescribing.Conclusion:Implementation strategies that enable clinicians to overcome diagnostic uncertainty, perceived patient demand, and improve patient education are desired. Implementation strategies were welcomed, and some were more readily accepted (eg, audit feedback) than others (eg, shared decision making). Implementation strategies should address clinicians’ perceptions of antibiotic prescribing practices and should enhance their patient communication skills.

Pharmacist-Driven Implementation of Outpatient Antibiotic Prescribing Algorithms Improves Guideline Adherence in the Emergency Department

2020 ◽  
pp. 089719002093097
Author(s):  
Kristin Stoll ◽  
Erik Feltz ◽  
Steven Ebert
Keyword(s):  
Emergency Department ◽  
Clinical Practice ◽  
Guideline Adherence ◽  
Inappropriate Prescribing ◽  
Community Acquired Pneumonia ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Duration Of Therapy ◽  
Tract Infections ◽  
Selection Of

Background: Inappropriate prescribing of antibiotics has been identified as the most important modifiable risk factor for antimicrobial resistance. Objective: The purpose of this project was to improve guideline adherence and promote optimal use of outpatient antibiotics in the emergency department (ED). Methods: Prescribing algorithms for community-acquired pneumonia (CAP), skin and soft tissue infections (SSTI), and urinary tract infections (UTI) were developed to integrate clinical practice guideline recommendations with local ED antibiogram data. Outcomes were evaluated through chart review of patients prescribed outpatient antibiotics by ED providers. The primary outcome was adherence to clinical practice guidelines, defined as the selection of an appropriate antibiotic agent, dose, and duration of therapy for each patient discharged. Results: When compared to patients discharged from the ED prior to algorithm implementation (N = 325), the post-implementation group (N = 353) received more antibiotic prescriptions that were completely guideline adherent (61.5% vs 11.7%, P < .00001). Post-implementation discharge orders demonstrated improvement in the selection of an appropriate agent (87.3% vs 45.5%, P < .00001), dose (91.5% vs 77.2%, P < .00001), and duration of therapy (71.1% vs 39.1%, P < .01). Additionally, fluoroquinolone prescribing rates were reduced (2.3% vs 12.3%, P < .00001). A reduction in all-cause 30-day returns to the ED or urgent care was observed (15.3% vs 21.5%, P = .036). Conclusion: Pharmacist-driven implementation of antibiotic prescribing algorithms improved guideline adherence in the outpatient treatment of CAP, SSTI, and UTI.

scholarly journals Antibiotic prescribing quality for children in primary care: an observational study

2018 ◽  
Vol 68 (667) ◽  
pp. e90-e96 ◽  
Author(s):  
Megan Rose Williams ◽  
Giles Greene ◽  
Gurudutt Naik ◽  
Kathryn Hughes ◽  
Christopher C Butler ◽  
...  
Keyword(s):  
Primary Care ◽  
Young Children ◽  
Otitis Media ◽  
Descriptive Analysis ◽  
Inappropriate Prescribing ◽  
Antibiotic Prescribing ◽  
Upper Respiratory Tract ◽  
Tract Infections ◽  
Disease Specific

BackgroundOveruse and inappropriate prescribing of antibiotics is driving antibiotic resistance. GPs often prescribe antibiotics for upper respiratory tract infections (URTIs) in young children despite their marginal beneficial effects.AimTo assess the quality of antibiotic prescribing for common infections in young children attending primary care and to investigate influencing factors.Design and settingAn observational, descriptive analysis, including children attending primary care sites in England and Wales.MethodThe Diagnosis of Urinary Tract infection in Young children study collected data on 7163 children aged <5 years, presenting to UK primary care with an acute illness (<28 days). Data were compared with the European Surveillance of Antimicrobial Consumption Network (ESAC-Net) disease-specific quality indicators to assess prescribing for URTIs, tonsillitis, and otitis media, against ESAC-Net proposed standards. Non-parametric trend tests and χ2tests assessed trends and differences in prescribing by level of deprivation, site type, and demographics.ResultsPrescribing rates fell within the recommendations for URTIs but exceeded the recommended limits for tonsillitis and otitis media. The proportion of children receiving the recommended antibiotic was below standards for URTIs and tonsillitis, but within the recommended limits for otitis media. Prescribing rates increased as the level of deprivation decreased for all infections (P<0.05), and increased as the age of the child increased for URTIs and tonsillitis (P<0.05). There were no other significant trends or differences.ConclusionThe quality of antibiotic prescribing in this study was mixed and highlights the scope for future improvements. There is a need to assess further the quality of disease-specific antibiotic prescribing in UK primary care settings using data representative of routine clinical practice.

scholarly journals Changes in the Management of Urinary Tract Infections in Women: Impact of the New Recommendations on Antibiotic Prescribing Behavior in France, Between 2014 and 2019

2021 ◽  
Author(s):  
Arthur Piraux ◽  
Sébastien Faure ◽  
Kurt G. Naber ◽  
Jakhongir F. ALIDJANOV ◽  
Aline Ramond-Roquin
Keyword(s):  
General Practitioners ◽  
Secondary Care ◽  
Administrative Database ◽  
Community Pharmacies ◽  
Antibiotic Prescribing ◽  
Prescribing Behavior ◽  
Using Data ◽  
New Guidelines ◽  
Tract Infections ◽  
Efficient Transmission

Abstract BackgroundUrinary tract infections (UTIs) are among the most common infections that require antibiotic therapy. In December 2015, new guidelines for UTI management were published in France with the aim of reducing antibiotic misuse and the risk of antimicrobial resistance.Objectives To analyze changes in antibiotic prescribing behavior for acute uncomplicated UTI in women in France from 2014 to 2019.MethodsRetrospective study using data extracted from the medico-administrative database 'OpenMedic' that is linked to the French National Health Data System and collects data on the reimbursement of prescribed drugs. The analyses focused on the number of boxes of antibiotics delivered by community pharmacies, the molecule class, and the prescriber's specialty.ResultsOverall, antibiotic dispensing by community pharmacies increased by 8% between 2014 and 2019, but with differences in function of the antibiotic class. The use of antibiotics recommended as first-line and second-line treatment increased (+ 41% for fosfomycin, + 7.53% for pivmecillinam). Conversely, the dispensing of lomefloxacin and norfloxacin decreased by 80%, and that of ciprofloxacin by 23%. Some antibiotics were mostly prescribed by general practitioners (lomefloxacin, pivmecillinam) and others by secondary care physicians (ofloxacin). The dispensing increase was higher for antibiotics prescribed by secondary care physicians than general practitioners (+21% and +5% between 2014 and 2019). ConclusionThese data suggest that the new recommendations are followed, as indicated by the increased prescription of fosfomycin and pivmecillinam and decreased prescription of fluoroquinolones. However, the efficient transmission and implementation of new recommendations by practitioners requires time, means and dedicated tools.

Antibiotics and the development of resistant microorganisms. Can homeopathy be an alternative?

Homeopathy ◽  
2003 ◽  
Vol 92 (02) ◽  
pp. 99-107
Author(s):  
Petter Viksveen
Keyword(s):  
Antibiotic Resistance ◽  
Public Health Problem ◽  
Animal Husbandry ◽  
Resistant Bacteria ◽  
Antibiotic Prescribing ◽  
Upper Respiratory Tract ◽  
Global Public Health ◽  
Agricultural Applications ◽  
Tract Infections ◽  
Almost All

AbstractAntibiotic resistance is a global public health problem. Once confined primarily to hospitals it is now increasingly common in primary care. The prevalence of resistant bacteria is rising, and organisms resistant to almost all antibiotics have been identified. The main causes are indiscriminate prescribing and the use of antibiotics in animal feeds and other agricultural applications. Policies to restrict use of antibiotics have had limited success. Homeopathy may have a role to play in combating the development of antibiotic resistance. Clinical research suggests that homeopathy is effective in the treatment of upper respiratory tract infections in children, a frequent cause of inappropriate antibiotic prescribing. The EU recommends the use of homeopathy in organic animal husbandry, and it is used by significant numbers of farmers. At present there is little data on the effectiveness of homeopathy in this setting. Further research should be done.

scholarly journals Antibiotic prescription among outpatients in a prefecture of Japan, 2012–2013: a retrospective claims database study

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e026251 ◽  
Author(s):  
Hideki Hashimoto ◽  
Hiroki Matsui ◽  
Yusuke Sasabuchi ◽  
Hideo Yasunaga ◽  
Kazuhiko Kotani ◽  
...  
Keyword(s):  
Health Insurance ◽  
Inappropriate Prescribing ◽  
Multivariable Analysis ◽  
Young Patients ◽  
Prescribing Patterns ◽  
Small Scale ◽  
Antibiotic Prescribing ◽  
Oral Antibiotic ◽  
Gastrointestinal Infections ◽  
Tract Infections

ObjectivesTo investigate oral antibiotic prescribing patterns and identify factors associated with antibiotic prescriptions, with the aim of guiding future interventions to reduce inappropriate prescribing.DesignRetrospective cohort study.SettingDatabase of public health insurance claims in Kumamoto prefecture (Japan).ParticipantsBeneficiaries of the national or late elders’ health insurance system between April 2012 and March 2013.Main outcome measuresOf the 7 770 481 outpatient visits, 682 822 had a code for antibiotics (860 antibiotic prescriptions per 1000 population). Third-generation cephalosporins (35%), macrolides (32%) and quinolones (21%) were the most frequently prescribed. Acute respiratory tract infections (ARTIs), including viral upper respiratory infections (URI) (22%), pharyngitis (18%), bronchitis (11%) and sinusitis (10%) were the most frequently diagnosed for antibiotic prescribing, followed by gastrointestinal (9%), urinary tract (8%) and skin, cutaneous and mucosal infections (5%). Antibiotic prescribing rates for viral URI, pharyngitis, bronchitis, sinusitis and gastrointestinal infections were 35%, 54%, 53%, 57% and 30%, respectively. In multivariable analysis for ARTIs and gastrointestinal infections, patient age (10–19 years especially), patient sex (male) and facility scale (free-standing clinics or small-scale hospital-based clinics) were associated with increased antibiotic prescribing.ConclusionsBroad-spectrum antibiotics constituted 88% of oral outpatient antibiotic prescriptions. Approximately 70% of antibiotics were prescribed for ARTIs and gastroenteritis with modest benefit from antibiotic treatment. The quality of antibiotic prescribing needs to be improved. Antimicrobial stewardship interventions should target ARTIs and gastroenteritis, as well as young patients and small-scale institutions.

scholarly journals Physicians under Pressure: Evidence from Antibiotics Prescribing in England

2022 ◽  
pp. 0272989X2110699
Author(s):  
Thomas Allen ◽  
Dorte Gyrd-Hansen ◽  
Søren Rud Kristensen ◽  
Anne Sophie Oxholm ◽  
Line Bjørnskov Pedersen ◽  
...  
Keyword(s):  
General Practitioners ◽  
Broad Spectrum ◽  
Fixed Effects ◽  
Linear Models ◽  
Inappropriate Prescribing ◽  
Antibiotic Prescribing ◽  
Policy Makers ◽  
Societal Costs ◽  
Broad Spectrum Antibiotics ◽  
Different Sources

Background Many physicians are experiencing increasing demands from both their patients and society. Evidence is scarce on the consequences of the pressure on physicians’ decision making. We present a theoretical framework and predict that increasing pressure may make physicians disregard societal welfare when treating patients. Setting We test our prediction on general practitioners’ antibiotic-prescribing choices. Because prescribing broad-spectrum antibiotics does not require microbiological testing, it can be performed more quickly than prescribing for narrow-spectrum antibiotics and is therefore often preferred by the patient. In contrast, from a societal perspective, inappropriate prescribing of broad-spectrum antibiotics should be minimized as it may contribute to antimicrobial resistance in the general population. Methods We combine longitudinal survey data and administrative data from 2010 to 2017 to create a balanced panel of up to 1072 English general practitioners (GPs). Using a series of linear models with GP fixed effects, we estimate the importance of different sources of pressure for GPs’ prescribing. Results We find that the percentage of broad-spectrum antibiotics prescribed increases by 6.4% as pressure increases on English GPs. The link between pressure and prescribing holds for different sources of pressure. Conclusions Our findings suggest that there may be societal costs of physicians working under pressure. Policy makers need to take these costs into account when evaluating existing policies as well as when introducing new policies affecting physicians’ work pressure. An important avenue for further research is also to determine the underlying mechanisms related to the different sources of pressure.JEL-code: I11, J28, J45 Highlights Many physicians are working under increasing pressure. We test the importance of pressure on physicians’ prescribing of antibiotics. The prescribed rate of broad-spectrum antibiotics increases with pressure. Policy makers should be aware of the societal costs of pressured physicians. [Formula: see text]

scholarly journals Antibiotic Prescribing and Doctor-Patient Communication During Consultations for Respiratory Tract Infections: A Video Observation Study in Out-of-Hours Primary Care

2021 ◽  
Vol 8 ◽  
Author(s):  
Annelies Colliers ◽  
Katrien Bombeke ◽  
Hilde Philips ◽  
Roy Remmen ◽  
Samuel Coenen ◽  
...  
Keyword(s):  
Primary Care ◽  
Respiratory Tract ◽  
General Practitioners ◽  
Communication Skills ◽  
Respiratory Tract Infections ◽  
Patient Expectations ◽  
Antibiotic Prescribing ◽  
Out Of Hours ◽  
Doctor Patient Communication ◽  
Tract Infections

Objective: Communication skills can reduce inappropriate antibiotic prescribing, which could help to tackle antibiotic resistance. General practitioners often overestimate patient expectations for an antibiotic. In this study, we describe how general practitioners and patients with respiratory tract infections (RTI) communicate about their problem, including the reason for encounter and ideas, concerns, and expectations (ICE), and how this relates to (non-)antibiotic prescribing in out-of-hours (OOH) primary care.Methods: A qualitative descriptive framework analysis of video-recorded consultations during OOH primary care focusing on doctor-patient communication.Results: We analyzed 77 videos from 19 general practitioners. General practitioners using patient-centered communication skills received more information on the perspective of the patients on the illness period. For some patients, the reason for the encounter was motivated by their belief that a general practitioner (GP) visit will alter the course of their illness. The ideas, concerns, and expectations often remained implicit, but the concerns were expressed by the choice of words, tone of voice, repetition of words, etc. Delayed prescribing was sometimes used to respond to implicit patient expectations for an antibiotic. Patients accepted a non-antibiotic management plan well.Conclusion: Not addressing the ICE of patients, or their reason to consult the GP OOH, could drive assumptions about patient expectations for antibiotics early on and antibiotic prescribing later in the consultation.

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