TY - JOUR
T1 - Use of a Telemedicine Team to Improve Guideline-Based Antibiotic Prescribing
AU - van Ewijk, Catharina E.
AU - Schneeberger, Caroline
AU - Jacobs, Johanna M. M.
AU - Boutkourt, Firdaouss
AU - Aanhane, Femke E. M.
AU - Schim van der Loeff, Maarten F.
AU - Koene, Fleur M. H. P. A.
N1 - Funding Information: This work was funded by Research and Development from the Public Health Service of Amsterdam. Funding Information: The authors acknowledge Helma Westland, infection prevention expert, for her help extracting data from the residents' files and Ren? Verfaille, Medical Head of the Amsta nursing home group, and the physicians and other members of Amsta nursing home group for supporting and organizing the setup for our study. Publisher Copyright: © 2021 AMDA – The Society for Post-Acute and Long-Term Care Medicine
PY - 2021
Y1 - 2021
N2 - Objectives: Assessing the impact of a virtual antibiotic team (VAT) on appropriateness of antibiotic prescribing behavior of older care physicians, regarding urinary tract (UTI), respiratory tract (RTI), and skin and soft tissue infections (SSTI), in residents of long-term care facilities (LTCF). Design: Before-after trial; introduction of a VAT consisting of a clinical microbiologist, older care physician, and a pharmacist. Setting and participants: Eight LTCFs in Amsterdam, the Netherlands. Methods: The VAT was introduced on April 1, 2019. Meetings were held via weekly teleconferencing. VAT advised about treatment indication, antibiotic choice, and additional diagnostics. Data were retrospectively extracted from resident files regarding infection episodes for which antibiotics had been prescribed during 12 months before (period I) and 11 months after VAT introduction (period II). Appropriateness of antibiotic prescriptions was assessed using national guidelines and an algorithm developed for antimicrobial stewardship in nursing homes. Antibiotic prescription rates per 100 person-years (py) were estimated and compared between periods using incidence rate ratio (IRR) with 95% confidence intervals (CIs). Proportions of appropriate antibiotic prescriptions were compared between periods using the chi-squared test. Results: A total of 524 infection episodes for which antibiotics were prescribed were identified: 284 in period I and 240 in period II. Antibiotic prescription rates before VAT introduction were 73 per 100 py in period I and decreased to 68 in period II (IRR 0.9, 95% CI 0.8-1.1). Of all prescriptions, 23.9% were assessed as appropriate during period I, which increased to 40.4% in period II (P <.001). Appropriate antibiotic use increased after VAT introduction for RTI (12.5% to 48.2%, P <.001) and SSTI (47.5% to 74.3%, P =.02) but remained similar for UTI (23.5% to 28.8%, P =.29). Conclusions and Implications: After implementation of VAT in LTCFs, appropriate antibiotic use increased significantly overall, and for RTI and SSTI particularly. Improving prescribing behavior regarding UTI might need extra strategies.
AB - Objectives: Assessing the impact of a virtual antibiotic team (VAT) on appropriateness of antibiotic prescribing behavior of older care physicians, regarding urinary tract (UTI), respiratory tract (RTI), and skin and soft tissue infections (SSTI), in residents of long-term care facilities (LTCF). Design: Before-after trial; introduction of a VAT consisting of a clinical microbiologist, older care physician, and a pharmacist. Setting and participants: Eight LTCFs in Amsterdam, the Netherlands. Methods: The VAT was introduced on April 1, 2019. Meetings were held via weekly teleconferencing. VAT advised about treatment indication, antibiotic choice, and additional diagnostics. Data were retrospectively extracted from resident files regarding infection episodes for which antibiotics had been prescribed during 12 months before (period I) and 11 months after VAT introduction (period II). Appropriateness of antibiotic prescriptions was assessed using national guidelines and an algorithm developed for antimicrobial stewardship in nursing homes. Antibiotic prescription rates per 100 person-years (py) were estimated and compared between periods using incidence rate ratio (IRR) with 95% confidence intervals (CIs). Proportions of appropriate antibiotic prescriptions were compared between periods using the chi-squared test. Results: A total of 524 infection episodes for which antibiotics were prescribed were identified: 284 in period I and 240 in period II. Antibiotic prescription rates before VAT introduction were 73 per 100 py in period I and decreased to 68 in period II (IRR 0.9, 95% CI 0.8-1.1). Of all prescriptions, 23.9% were assessed as appropriate during period I, which increased to 40.4% in period II (P <.001). Appropriate antibiotic use increased after VAT introduction for RTI (12.5% to 48.2%, P <.001) and SSTI (47.5% to 74.3%, P =.02) but remained similar for UTI (23.5% to 28.8%, P =.29). Conclusions and Implications: After implementation of VAT in LTCFs, appropriate antibiotic use increased significantly overall, and for RTI and SSTI particularly. Improving prescribing behavior regarding UTI might need extra strategies.
KW - Nursing home
KW - antibiotic team
KW - antimicrobial stewardship
KW - elderly care
KW - long-term care facility
KW - prescribing behavior
UR - http://www.scopus.com/inward/record.url?scp=85118329084&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jamda.2021.09.031
DO - https://doi.org/10.1016/j.jamda.2021.09.031
M3 - Article
C2 - 34688608
SN - 1525-8610
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
ER -