JAC Advance Access published online on October 16, 2003
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkg460
© 2003 by The British Society for Antimicrobial Chemotherapy
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Original article
1 Health Services Research
Unit, University of Aberdeen, Aberdeen
* Corresponding author. E-mail: peter{at}memo.dundee.ac.uk.
Received 18 June 2003
; revised 28 August 2003
; accepted 28 August 2003
Introduction: In 1999, the British
Society for Antimicrobial Chemotherapy (BSAC) and Hospital Infection Society
(HIS) convened a working party on optimization of antibiotic prescribing
in hospitals. This study was undertaken in order to evaluate the
current evidence base on the effectiveness of interventions to change antibiotic
prescribing to hospital inpatients. Methods: We have systematically reviewed the
literature from 1980 to identify interventions that alone, or in combination,
are effective in improving antibiotic prescribing to hospital inpatients.
The protocol was peer reviewed and has been published by the Effective
Practice and Organization of Care (EPOC) Group of the Cochrane Collaboration
(). Results: We identified 306 papers, of which
91 (30%) met the minimum inclusion criteria for a Cochrane EPOC
review. The reasons for exclusion were uncontrolled before and after
design (141/306; 46%) and inadequate interrupted time series
(74/306; 24%) with fewer than three observations before
and after the intervention. Most of the rejected interrupted time
series (ITS) studies had only one or two data points before the
intervention with many (up to 15) after it. Only 15 (40%)
of the 38 included ITS studies had a statistical analysis and 11
of these used inappropriate statistical tests (e.g. t-test
of pre- and post-intervention mean data) rather than analysis of
time trends. Regression analysis of the proportion of included studies
by year of publication did show a significant positive correlation
(R2 = 0.7886). Nonetheless,
of 47 papers published since 2000, only 19 (40%) met the
minimum eligibility criteria. Conclusions: The majority of evaluations used
fundamentally flawed methodology. There is limited evidence of improvement
over time. These problems could be resolved if researchers and referees
of protocols or manuscripts implemented the EPOC methodology.
Keywords: prescribing interventions, controlled before
and after studies, interrupted time series, segmented regression analysis,
hospital antibiotic prescribing
Room for improvement: a systematic review of the
quality of evaluations of interventions to improve hospital antibiotic
prescribing
2 Department of Microbiology, Frenchay Hospital,
Bristol
3 Department of Pathology
and Microbiology, University of Bristol, Bristol
4 MEMO, Department of Clinical Pharmacology,
University of Dundee, Dundee DD1 9SY, UK
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