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首页> 外文期刊>Journal of Community Hospital Internal Medicine Perspectives >Improving antibiotic adherence in treatment of acute upper respiratory infections: a quality improvement process
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Improving antibiotic adherence in treatment of acute upper respiratory infections: a quality improvement process

机译：改善抗生素对急性上呼吸道感染的依从性：质量改善过程

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Introduction Approximately 25 million people in the United States visit their primary care physician each year for acute respiratory infections (ARI). They are a common cause of unnecessary prescription of antibiotics; despite well-validated national treatment guidelines, around 73% of adults with ARI are prescribed antibiotics in the United States. Inappropriate use of antibiotics has profound implications. Methods Our aim was to increase adherence to antibiotic guidelines for treatment of ARI in an internal medicine outpatient practice. We used a package of active and passive interventions to improve physician awareness of treatment guidelines; these included short sessions of didactic teaching, antibiotic guidelines posters in patient examination rooms and staff areas, clinical decision support (CDS) tools integrated into the electronic medical record system, guideline adherence report cards for providers, and reiteration of CDS tool use and guideline adherence at monthly group meetings. Process measures were the rate of use of CDS tools for the management of ARI and patient callbacks within 72 h for the same issue. Outcome measures were compliance with antibiotic prescribing guidelines. Results Our low-cost interventions led to a significant improvement in ARI treatment guideline adherence. There was improvement in compliance with treatment guidelines for sinusitis (90.90% vs. 57.58%, p <0.001), pharyngitis (64.28% vs. 25.00%, p =0.003), upper respiratory infection (96.18% vs. 73.68%, p =0.008), and the aggregated measure of ARI (91.25% vs. 78.6%, p <0.001). Rate of CDS tool usage was 40.5% with a 72-h callback rate of 0.05%. Conclusion Simple, low-cost interventions can improve appropriate antibiotic use for ARI and change the prescribing habits of providers in an outpatient setting. Provider and patient education is a vital component of antibiotic stewardship. Simple interventions for common outpatient conditions can have a positive impact on patient outcomes and reduce unnecessary healthcare costs.
机译：简介每年，美国大约有2500万人就其急性呼吸道感染（ARI）拜访其初级保健医生。它们是不必要的抗生素处方的常见原因。尽管有完善的国民治疗指南，但在美国约有73％的成人ARI是处方抗生素。抗生素的不当使用具有深远的意义。方法我们的目的是在内科门诊实践中增加对抗生素治疗ARI指南的依从性。我们使用了一整套主动和被动干预措施，以提高医师对治疗指南的认识;这些措施包括短期教学法，在患者检查室和工作人员区域使用抗生素指南海报，集成到电子病历系统中的临床决策支持（CDS）工具，提供者的指南遵守情况报告卡以及重申CDS工具使用和指南遵守情况在每月的小组会议上。处理措施是使用CDS工具管理ARI和72小时内针对同一问题的患者回拨的比率。结果措施是遵守抗生素处方指南。结果我们的低成本干预措施大大改善了ARI治疗指南的依从性。鼻窦炎（90.90％vs. 57.58％，p <0.001），咽炎（64.28％vs. 25.00％，p = 0.003），上呼吸道感染（96.18％vs. 73.68％，p = 0.008），以及ARI的汇总指标（91.25％对78.6％，p <0.001）。 CDS工具的使用率为40.5％，其中72小时的回调率为0.05％。结论简单，低成本的干预措施可以改善ARI的适当抗生素使用情况，并改变门诊病人提供者的处方习惯。提供者和患者的教育是抗生素管理的重要组成部分。普通门诊病人的简单干预措施可以对患者的预后产生积极影响，并减少不必要的医疗费用。

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