Outcomes of an intervention to improve hospital antibiotic prescribing: interrupted time series with segmented regression analysis

F. Ansari, K. Gray, D. Nathwani, G. Phillips, S. Ogston, Craig R Ramsay, P. Davey

Research output: Contribution to journalArticle

161 Citations (Scopus)

Abstract

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 pound1908 per month (95% CI pound1238-pound2578). The cost of development, dissemination and implementation of the intervention (pound20 133) was well below the most conservative estimate of the reduction in cost (pound133 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 pound572 448 (95% CI pound435 696-pound709 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.

Original languageEnglish
Pages (from-to)842-848
Number of pages6
JournalJournal of Antimicrobial Chemotherapy
Volume52
DOIs
Publication statusPublished - 2003

Keywords

  • education
  • professional behaviour change
  • quality improvement
  • ECONOMIC OUTCOMES
  • TRACT INFECTION
  • GUIDELINES
  • QUALITY
  • MISUSE

Cite this

Outcomes of an intervention to improve hospital antibiotic prescribing: interrupted time series with segmented regression analysis. / Ansari, F.; Gray, K.; Nathwani, D.; Phillips, G.; Ogston, S.; Ramsay, Craig R; Davey, P.

In: Journal of Antimicrobial Chemotherapy, Vol. 52, 2003, p. 842-848.

Research output: Contribution to journalArticle

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title = "Outcomes of an intervention to improve hospital antibiotic prescribing: interrupted time series with segmented regression analysis",
abstract = "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 pound1908 per month (95{\%} CI pound1238-pound2578). The cost of development, dissemination and implementation of the intervention (pound20 133) was well below the most conservative estimate of the reduction in cost (pound133 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 pound572 448 (95{\%} CI pound435 696-pound709 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.",
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T1 - Outcomes of an intervention to improve hospital antibiotic prescribing: interrupted time series with segmented regression analysis

AU - Ansari, F.

AU - Gray, K.

AU - Nathwani, D.

AU - Phillips, G.

AU - Ogston, S.

AU - Ramsay, Craig R

AU - Davey, P.

PY - 2003

Y1 - 2003

N2 - 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 pound1908 per month (95% CI pound1238-pound2578). The cost of development, dissemination and implementation of the intervention (pound20 133) was well below the most conservative estimate of the reduction in cost (pound133 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 pound572 448 (95% CI pound435 696-pound709 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.

AB - 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 pound1908 per month (95% CI pound1238-pound2578). The cost of development, dissemination and implementation of the intervention (pound20 133) was well below the most conservative estimate of the reduction in cost (pound133 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 pound572 448 (95% CI pound435 696-pound709 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.

KW - education

KW - professional behaviour change

KW - quality improvement

KW - ECONOMIC OUTCOMES

KW - TRACT INFECTION

KW - GUIDELINES

KW - QUALITY

KW - MISUSE

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DO - 10.1093/jac/dkg459

M3 - Article

VL - 52

SP - 842

EP - 848

JO - Journal of Antimicrobial Chemotherapy

JF - Journal of Antimicrobial Chemotherapy

SN - 0305-7453

ER -