scholarly journals Insertion of a Clinical Pathway Pop-Up Window into a Computer-Based Prescription System: A Method to Promote Antibiotic Stewardship in Upper Respiratory Tract Infection

Antibiotics ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 1479
Author(s):  
Wantin Sribenjalux ◽  
Nattawat Larbsida ◽  
Sittichai Khamsai ◽  
Benjaphol Panyapornsakul ◽  
Phitphiboon Deawtrakulchai ◽  
...  
Keyword(s):  
Primary Care ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Clinical Pathway ◽  
Antibiotic Prescription ◽  
The Other ◽  
Upper Respiratory Tract ◽  
Post Intervention ◽  
Computer Based ◽  
Upper Respiratory

Outpatient antibiotics are most frequently prescribed for upper respiratory tract infection (URI); however, most such prescriptions are inappropriate. We aimed to determine the effect of an electronic clinical pathway on the rates of overall and rational prescription of antibiotics in patients with URI. A pilot quasi-experimental study was conducted in a university hospital and two of its nearby primary care units (PCU) in northeast Thailand from June to September 2020. Clinical pathway pop-up windows were inserted into the hospital’s computer-based prescription system. Care providers were required to check the appropriate boxes before they were able to prescribe amoxicillin or co-amoxiclav. We examined a total of 675 visits to the outpatient department due to URI at three points in time: pre-intervention, immediately post-intervention, and 6 weeks post-intervention. Patients in the latter group tended to be younger and visits were more likely to be general practitioner-related and to the student PCU than in the other two groups. In addition, the rate of antibiotic prescription was significantly lower at 6 weeks after intervention than at either of the other time periods (32.0% vs 53.8% pre-intervention and 46.2% immediately post-intervention; p < 0.001), and the proportion of rational antibiotic prescriptions increased significantly after implementation. Antibiotic prescription rates were lower at the community primary care unit and higher when the physician was a resident or a family doctor. The deployment of an electronic clinical pathway reduced the rate of unnecessary antibiotic prescriptions. The effect was greater at 6 weeks post-implementation. However, discrepancy of patients’ baseline characteristics may have skewed the findings.

scholarly journals Antibiotic prescription for under-fives with common cold or upper respiratory tract infection in Savannakhet Province, Lao PDR

2019 ◽  
Vol 47 (1) ◽  
Author(s):  
Bounxou Keohavong ◽  
Manithong Vonglokham ◽  
Bounfeng Phoummalaysith ◽  
Viengsakhone Louangpradith ◽  
Souphalak Inthaphatha ◽  
...  
Keyword(s):  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Common Cold ◽  
Antibiotic Prescription ◽  
Lao Pdr ◽  
Upper Respiratory Tract Infection ◽  
Upper Respiratory Tract ◽  
Upper Respiratory

‘Unilateral’ decision making and patient participation in primary care

2012 ◽  
Vol 8 (2) ◽  
pp. 145-155 ◽  
Author(s):  
Taru Ijäs-Kallio ◽  
Johanna Ruusuvuori ◽  
Anssi Peräkylä
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Conversation Analysis ◽  
Treatment Decision ◽  
Decision Making Process ◽  
Upper Respiratory Tract ◽  
Upper Respiratory ◽  
Patients Acceptance

Using conversation analysis as a method, we examine patients’ responses to doctors’ treatment decision deliveries in Finnish primary care consultations for upper respiratory tract infection. We investigate decision-making sequences that are initiated by doctors’ ‘unilateral’ decision delivery (Collins et al. 2005). In line with Collins et al., we see the doctors’ decision deliveries as unilateral when they are offered as suggestions, recommendations or conclusions that make relevant patients’ acceptance of the decision rather than their further contributions to the decision. In contrast, more ‘bilateral’ decision making encourages and is dependent in part on patient’s contributions, too (Collins et al. 2005). We examine how patients respond to unilaterally made decisions and how they participate in and contribute to the outcome of the decision-making process. Within minimal responses patients approve the doctor’s unilateral agency in decision making whereas within two types of extended responses patients voice their own perspectives. 1) In positive responses they appraise the doctor’s decision as appropriate; 2) in other instances, patients may challenge the decision with an extended response that initiates a negotiation on the decision. We suggest that, firstly, unilateral decision making may be collaboratively maintained in consultations and that, secondly, patients have means for challenging it.

scholarly journals 1466. Antibiotic utilization reports may reduce prescribing practices for Upper Respiratory Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S735-S735
Author(s):  
David Augusto Terrero Salcedo ◽  
Allison Kelly ◽  
Victoria Tate
Keyword(s):  
Emergency Department ◽  
Respiratory Tract ◽  
Antibiotic Prescription ◽  
Upper Respiratory Tract ◽  
Care Providers ◽  
Post Intervention ◽  
Face To Face ◽  
Antibiotic Utilization ◽  
Upper Respiratory ◽  
Tract Infections

Abstract Background More than 90% of Upper respiratory tract infections (URI) have a viral etiology; nonetheless, these represent the most common reason for ambulatory antibiotic prescription. This translates in higher risk of antibiotic-related adverse events and promotion of antimicrobial resistance. Methods A prospective single-center intervention surveying and providing individual, face-to-face comparative reports of antibiotic utilization, for any of the 4 diagnostic entities that constitute upper respiratory tract infection (common cold, pharyngitis, acute rhinosinusitis and acute bronchitis), was performed in our Emergency Department. Example of monthly provider reports used which included general and individualized goals. Results A total of 12 health care providers were followed for 12 months. Education, prescribing reports and individual goals were provided. The pre-intervention prescription rate from September to December 2018 averaged 74.75% (SD 20.59, 95% CI 61.6-87.8), with a post-intervention rate of 55.5% from September to December of 2019 (SD 19.20, 95% CI 43.3-67.7) that was statistically significant (p=0.0036). A higher use of antibiotic was observed in physicians when compared to non-physician providers in both pre and post intervention stages (reduction of 16.6% vs 23% after intervention respectively), with no statistical difference between the two groups (CI 95% of -38.82 to 2.395, p=0.0773). A proposed target of 50% or less was observed in 5 of 12 providers (41.6%), and 2 out of 12 (16.7%) had increase in their antibiotic utilization rate. Comparative use of antimicrobials in the pre (September-December 2018) and post (September-December 2019) - intervention periods. Average individual antimicrobial use rate before and after intervention. Conclusion Routine face-to-face utilization reports may constitute an effective approach in reducing antibiotic prescription practices in the Emergency Department, and potentially, in other outpatient healthcare settings. Disclosures All Authors: No reported disclosures

scholarly journals Self-medication with antibiotics among patients attending a Malaysian primary care clinic: a preliminary study

2021 ◽  
Vol 8 (2) ◽  
pp. 542
Author(s):  
Zati Sabrina Ahmad Zubaidi
Keyword(s):  
Primary Care ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Upper Respiratory Tract Infection ◽  
Upper Respiratory Tract ◽  
Self Medication ◽  
Care Clinic ◽  
Upper Respiratory ◽  
At Home

Background: Research on self-medication with antibiotic in Malaysian primary care clinics are limited. This study aimed to assess the practice of self-medication with antibiotic, self-recognized complaints to self-medicate, antibiotic knowledge, attitudes towards antibiotic and potential association to self-medicate in a primary care clinic.Methods: This was a community-based pilot study using a self-administered questionnaire among 281 respondents. Chi square test and independent T test were performed to identify potential associations to self-medication.Results: The prevalence of self-medication with antibiotic was 13.3%. The most common complain to self-medicate was for upper respiratory tract infection (58.8%). Majority of them were able to self-purchased antibiotics (55.9%). 70.6% of respondents who SMA understood that overuse of antibiotic results in antibiotic resistance. Interestingly, antibiotic knowledge among respondents who self-medicate was higher (6.50±1.93) compared to those who did not (5.85±2.46) albeit not statistically significant. However, respondents who self-medicate had poorer attitude towards antibiotic compared to those who did not and this was statistically significant, t (254)=0-4.25, p=0.0001. 95% CI (-4.653, 1.709). This includes keeping antibiotics at home and using leftover antibiotics for respiratory illness.Conclusions: Self-medication with antibiotic in this population is low. Inappropriate attitude towards antibiotic is associated with self-medication with antibiotic. Antibiotic campaigns should focus on improving the community’s attitude towards antibiotic especially pertaining to educating the public against keeping antibiotic at home and using leftover antibiotics for upper respiratory tract infection. The findings demonstrated the need and feasibility of the study protocol for future research. 

scholarly journals Reducing inappropriate antibiotic prescribing in upper respiratory tract infection in a primary care setting in Kolkata, India

2018 ◽  
Vol 7 (4) ◽  
pp. e000217 ◽  
Author(s):  
Amy Dehn Lunn
Keyword(s):  
Primary Care ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Antibiotic Use ◽  
Multifaceted Intervention ◽  
Upper Respiratory Tract Infection ◽  
Antibiotic Prescribing ◽  
Upper Respiratory Tract ◽  
Upper Respiratory

Inappropriate antibiotic use is a key factor in the emergence of antibiotic resistance. The majority of antibiotics are prescribed in primary care, where upper respiratory tract infection (URTI) is a common presentation. Inappropriate antibiotic prescribing in URTI is common globally and has increased markedly in developing and transitional countries. Antibiotic stewardship is crucial to prevent the emergence and spread of resistant microbes. This project aimed to reduce inappropriate antibiotic prescribing in URTI in a non-governmental organisation’s primary care outreach clinics in Kolkata, India, from 62.6% to 30% over 4 months. A multifaceted intervention to reduce inappropriate antibiotic use in non-specific URTI was implemented. This consisted of a repeated process of audit and feedback, interactive training sessions, one-to-one case-based discussion, antibiotic guideline development and coding updates. The primary outcome measure was antibiotic prescribing rates. A baseline audit of all patients presenting with non-specific URTI over 8 weeks in November and December 2016 (n=222) found that 62.6% were prescribed antibiotics. Postintervention audit over 4 weeks in April 2017 (n=69) showed a marked reduction in antibiotic prescribing to 7.2%. An increase in documentation of examination findings was also observed, from 52.7% to 95.6%. This multifaceted intervention was successful at reducing inappropriate antibiotic prescribing, with sustained reductions demonstrated over the 4 months of the project. This suggests that approaches previously used in Europe can successfully be applied to different settings.

scholarly journals Delayed antibiotic prescription in upper respiratory tract infections: a new trend?

2021 ◽  
Vol 31 (Supplement_2) ◽  
Author(s):  
Carolina Castanheira ◽  
Isabel Andrade ◽  
Rui Cruz
Keyword(s):  
Primary Care ◽  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Antibiotic Prescription ◽  
Upper Respiratory Tract Infections ◽  
Upper Respiratory Tract ◽  
Rapid Tests ◽  
Upper Respiratory ◽  
Tract Infections ◽  
Delayed Antibiotic Prescription

Abstract Background Upper respiratory tract infections (URTI) are one of the main reasons for consultation in primary care. Approximately 60% of all antibiotic prescriptions aim at the treatment of URTI, even without a laboratory-based diagnosis. Delayed antibiotic prescription in primary care has shown to reduce antibiotic consumption, without increasing risk of complications, yet is not widely used. Rapid tests to confirm the etiology of URTI are available at pharmacies, but not purchased routinely. In this context, the aim of this study is to assess the knowledge of rapid tests for the diagnosis of URTI, and the awareness of strategies to decrease antibiotic use. Methods A team of experts in the field developed a questionnaire specifically for the purpose of this study. The Pharmacy graduate students of ESTESC-Coimbra Health School (Portugal) answered the questionnaire online. Results Over 90% of the respondents with a URTI stated that the general practitioner prescribed the antibiotic without a lab test. When given the option, 58% are willing to pay up to 50 Euros for a rapid test, yet are not familiar with any brand. Although the respondents aren’t familiarized with the concept, when asked, the majority (87%) are more likely to choose a delayed than an immediate prescription. Conclusions Pharmacy graduates are willing to support the use of delayed prescription, to give time for the lab confirmation of the diagnosis. A broader dissemination of the clinical evidence supporting the use of rapid tests and of delayed prescription is necessary to help managing URTI.

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