Anti-Infectives Adverse Reaction
Conditions
Keywords
intravenous antibiotics, appropriateness, outpatient antimicrobial therapy
Brief summary
A quasi-experimental study was conducted among patients receiving care at the medicine units of the Maharaj Nakorn Chiang Mai Hospital to determine the appropriateness of intravenous antibiotics at hospital discharge with and without ID consultation.
Detailed description
The pre-intervention period was started from November 1, 2015 to April 30, 2016 (6-month period), in which the intravenous antibiotics at hospital discharge were prescribed by the primary care team. The post-intervention period was started from May 1, 2016 to February 28, 2017 (10-month period), in which the intravenous antibiotics at hospital discharge were reviewed and intervened by ID team. The appropriateness of intravenous antibiotics was assessed separately by the ID fellow and ID specialist. If disagreement occurred, the feedback to the ID fellow was performed and the decision by ID specialist was used in the final analysis of appropriateness. In post-intervention period, ID fellow modified the intravenous antibiotics ordered by the primary team if those intravenous antibiotics were judged as inappropriate by ID fellow as follows: 1) discontinue intravenous antibiotics (treatment was complete), 2) switch to oral antibiotics, 3) change intravenous antibiotics to cover isolated pathogens, 4) adjust the dose of intravenous antibiotics, and 5) change the duration of intravenous antibiotics Finally, ID specialist retrospectively assessed the appropriateness of intravenous antibiotics at hospital discharge managed by ID fellow in post-intervention period.
Interventions
PROCEDUREID specialist approval
Appropriateness of intravenous antibiotics ordered by the primary team was assessed by ID specialist. ID fellow modified the intravenous antibiotics ordered by the primary team if those intravenous antibiotics were judged as inappropriate by ID fellow as follows: 1) discontinue intravenous antibiotics (treatment was complete), 2) switch to oral antibiotics, 3) change intravenous antibiotics to cover isolated pathogens, 4) adjust the dose of intravenous antibiotics, and 5) change the duration of intravenous antibiotics. Finally, ID specialist retrospectively assessed the appropriateness of intravenous antibiotics at hospital discharge managed by ID fellow in post-intervention period.
Sponsors
Chiang Mai University
Study design
Allocation
NON_RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
15 Years to No maximum
Healthy volunteers
No
Inclusion criteria
All adult patients who met the following criteria were consecutively enrolled; 1. age≥ 15 years old and 2. had infections at any sites and received intravenous antibiotics.
Exclusion criteria
\- They were evaluated by infectious diseases specialist for appropriate antibiotics during admission
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The proportion of appropriateness of intravenous antibiotics prescriptions at hospital discharge between groups | 16 months | To calculate the number of antibiotic prescriptions at hospital discharge over the total number of prescriptions, comparing between pre-and post-intervention period. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The costs of antibiotics for the course of treatment | 16 months | To compare the cost of antibiotics for the course of treatment between the 2 periods |
| Clinical improvement at 1 week | 1 week | To calculate the number of patients who had clinical improvement at 1 week over the total number of patients in each period, comparing between the 2 periods |
| Readmission within 30 days, length of hospital stay | 30 days | To calculate the number of patients who were readmitted within 30 days over the total number of patients in each period, comparing between the 2 periods |
| Length of hospital stay | 60 days | To calculate the length of hospital stays in days between 2 periods |
Countries
Thailand
Outcome results
None listed