TY - JOUR
T1 - An Electronic Health Record Integrated Decision Tool and Supportive Interventions to Improve Antibiotic Prescribing for Urinary Tract Infections in Nursing Homes
T2 - A Cluster Randomized Controlled Trial
AU - Rutten, Jeanine J S
AU - van Buul, Laura W
AU - Smalbrugge, Martin
AU - Geerlings, Suzanne E
AU - Gerritsen, Debby L
AU - Natsch, Stephanie
AU - Sloane, Philip D
AU - van der Wouden, Johannes C
AU - Twisk, Jos W R
AU - Hertogh, Cees M P M
N1 - Funding Information:
This work was supported by the Netherlands Organisation for Health Research and Development (ZonMw, grant no. 839120008).We thank the participating nursing homes (residents and staff) for their participation in this study, and Jorna van Eijk (research assistant) for her contributions to preparation, execution, and management of collected data. We also thank Gerimedica (electronic health record software supplier) for the development of the electronic case report forms and the integration of the decision tool in the electronic health record. The funding body (ie, The Netherlands Organisation for Health Research and Development, Netherlands [ZonMw]) had no role in study design, methods, subject recruitment, data collection, analysis, and preparation of this article.
Funding Information:
This work was supported by the Netherlands Organisation for Health Research and Development (ZonMw, grant no. 839120008 ).
Publisher Copyright:
© 2021 The Authors
PY - 2021/12/9
Y1 - 2021/12/9
N2 - OBJECTIVE: To investigate whether an electronic health record (EHR)-integrated decision tool, combined with supportive interventions, results in more appropriate antibiotic prescribing in nursing home (NH) residents with suspected urinary tract infection (UTI), without negative consequences for residents.DESIGN: Cluster randomized controlled trial with NHs as the randomization unit; intervention group NHs received the EHR-integrated decision tool and supportive interventions, and control group NHs provided care as usual.SETTING AND PARTICIPANTS: 212 residents with suspected UTI, from 16 NHs in the Netherlands.METHODS: Physicians collected data at index consultation (ie, UTI suspicion) and during a 21-day follow-up period (March 2019-March 2020). Overall antibiotic prescribing data at NH level, 12 months prior to and during the study, was derived from the electronic prescribing system. The primary study outcome was the percentage of antibiotic prescriptions for suspected UTI that was appropriate, at index consultation. Secondary study outcomes included changes in treatment decision, complications, UTI-related hospitalization, and mortality during follow-up; and pre-post study changes in antibiotic prescribing at the NH level.RESULTS: 295 suspected UTIs were included (intervention group: 189; control group: 106). The between-group difference in appropriate antibiotic prescribing was 13% [intervention group: 62%, control group: 49%; adjusted odds ratio (OR) 1.43, 95% CI 0.57-3.62]. In both groups, complications (2% vs 3%), UTI-related hospitalization (2% vs 1%), and possible UTI-related mortality (2% vs 2%) were rare. The pre-post study difference in antibiotic prescriptions per 1000 resident-care days was -0.95 in the intervention group NHs and -0.05 in the control group NHs (P = .02).CONCLUSION AND IMPLICATIONS: Although appropriate antibiotic prescribing improved in the intervention group, this does not provide sufficient evidence for our multidisciplinary intervention. Despite this inconclusive result, our intervention could potentially still be effective, because we established a large reduction in the number of antibiotic prescriptions in the intervention group.
AB - OBJECTIVE: To investigate whether an electronic health record (EHR)-integrated decision tool, combined with supportive interventions, results in more appropriate antibiotic prescribing in nursing home (NH) residents with suspected urinary tract infection (UTI), without negative consequences for residents.DESIGN: Cluster randomized controlled trial with NHs as the randomization unit; intervention group NHs received the EHR-integrated decision tool and supportive interventions, and control group NHs provided care as usual.SETTING AND PARTICIPANTS: 212 residents with suspected UTI, from 16 NHs in the Netherlands.METHODS: Physicians collected data at index consultation (ie, UTI suspicion) and during a 21-day follow-up period (March 2019-March 2020). Overall antibiotic prescribing data at NH level, 12 months prior to and during the study, was derived from the electronic prescribing system. The primary study outcome was the percentage of antibiotic prescriptions for suspected UTI that was appropriate, at index consultation. Secondary study outcomes included changes in treatment decision, complications, UTI-related hospitalization, and mortality during follow-up; and pre-post study changes in antibiotic prescribing at the NH level.RESULTS: 295 suspected UTIs were included (intervention group: 189; control group: 106). The between-group difference in appropriate antibiotic prescribing was 13% [intervention group: 62%, control group: 49%; adjusted odds ratio (OR) 1.43, 95% CI 0.57-3.62]. In both groups, complications (2% vs 3%), UTI-related hospitalization (2% vs 1%), and possible UTI-related mortality (2% vs 2%) were rare. The pre-post study difference in antibiotic prescriptions per 1000 resident-care days was -0.95 in the intervention group NHs and -0.05 in the control group NHs (P = .02).CONCLUSION AND IMPLICATIONS: Although appropriate antibiotic prescribing improved in the intervention group, this does not provide sufficient evidence for our multidisciplinary intervention. Despite this inconclusive result, our intervention could potentially still be effective, because we established a large reduction in the number of antibiotic prescriptions in the intervention group.
KW - Long-term care facilities
KW - antibiotic stewardship
KW - education
KW - electronic decision support
KW - treatment decision tool
KW - urinary tract infection
UR - http://www.scopus.com/inward/record.url?scp=85122641782&partnerID=8YFLogxK
U2 - 10.1016/j.jamda.2021.11.010
DO - 10.1016/j.jamda.2021.11.010
M3 - Article
C2 - 34896069
SN - 1525-8610
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
ER -