JAC Advance Access published online on October 16, 2003
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkg459
© 2003 by The British Society for Antimicrobial Chemotherapy
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Original article
1 MEMO (Medicines Monitoring
Unit), Department of Clinical Pharmacology, University of Dundee,
Dundee DD1 9SY
* Corresponding author. E-mail: peter{at}memo.dundee.ac.uk.
Received 18 June 2003
; revised 27 August 2003
; accepted 28 August 2003
Objectives: To evaluate an intervention
to reduce inappropriate use of key antibiotics with interrupted
time series analysis. Methods: The intervention is a policy for appropriate
use of Alert Antibiotics (carbapenems, glycopeptides, amphotericin,
ciprofloxacin, linezolid, piperacillin-tazobactam and third-generation
cephalosporins) implemented through concurrent, patient-specific
feedback by clinical pharmacists. Statistical significance and effect
size were calculated by segmented regression analysis of interrupted
time series of drug use and cost for 2 years before and after the
intervention started. Results: Use of Alert Antibiotics increased
before the intervention started but decreased steadily for 2 years thereafter.
The changes in slope of the time series were 0.27 defined daily
doses/100 bed-days per month (95% CI 0.19-0.34)
and £1908 per month (95% CI £1238-£2578).
The cost of development, dissemination and implementation of the
intervention (£20 133) was well below the most conservative
estimate of the reduction in cost (£133 296), which is
the lower 95% CI of effect size assuming that cost would
not have continued to increase without the intervention. However,
if use had continued to increase, the difference between predicted
and actual cost of Alert Antibiotics was £572 448 (95% CI £435
696-£709 176) over the 24 months after the intervention
started. Conclusions: Segmented regression analysis of
pharmacy stock data is a simple, practical and robust method for
measuring the impact of interventions to change prescribing. The
Alert Antibiotic Monitoring intervention was associated with significant
decreases in total use and cost in the 2 years after the programme
was implemented. In our hospital, the value of the data far exceeded
the cost of processing and analysis.
Keywords: education, professional behaviour change, quality
improvement
Outcomes of an intervention to improve hospital
antibiotic prescribing: interrupted time series with segmented regression
analysis
2 Departments of Pharmacy, Ninewells Hospital, Dundee
3 Department of Infectious Diseases, Ninewells Hospital, Dundee
4 Department of Medical Microbiology,
Ninewells Hospital, Dundee
5 Department
of Epidemiology and Public Health, University of Dundee, Dundee
6 Health Services Research Unit,
University of Aberdeen, Aberdeen, UK
7 MEMO (Medicines Monitoring
Unit), Department of Clinical Pharmacology, University of Dundee,
Dundee DD1 9SY; Departments of Infectious
Diseases, Ninewells Hospital, Dundee
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